JB Learning Registry Practice Test – Flashcards
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You are giving a presentation to a group of laypeople on the importance of calling EMS immediately for cardiac arrest patients. What point should you emphasize the MOST? A: CPR and defibrillation are key factors in patient survival. B: Laypeople are incapable of providing adequate CPR. C: Rapid transport significantly reduces patient mortality. D: Cardiac drug therapy is the most important EMS treatment.
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A: CPR and defibrillation are key factors in patient survival. Early high-quality CPR and defibrillation are the most crucial initial treatments to provide to a patient in cardiac arrest. Adequately performed CPR can keep the heart and brain oxygenated, thus increasing the chance of defibrillation success. Ventricular fibrillation (V-Fib) is the most common initial dysrhythmia seen in adult patients with sudden cardiac arrest and requires prompt defibrillation. Untreated V-Fib will rapidly deteriorate to asystole, the mortality rate from which is very high. You should also advise the audience that compression-only CPR has been linked to patient survival.
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Prior to your arrival, a woman experiencing an asthma attack took two puffs from her prescribed inhaler without relief. After administering supplemental oxygen, you should: A: perform a detailed secondary assessment. B: contact medical control for further advice. C: provide immediate transport to the hospital. D: administer one more puff from her inhaler.
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B: contact medical control for further advice. Before assisting a patient with any medication other than oxygen, the EMT must ensure that the medication is prescribed to the patient and then obtain authorization from medical control. In this case, the physician probably will allow you to help the patient take one more puff from her inhaler. Generally, up to three puffs from an inhaler are delivered in the field. It is important for you to ask the patient how many puffs were taken from the inhaler before you arrived. The EMT must correct any airway and/or breathing problems as quickly as possible. After doing so, a secondary assessment can be performed.
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In addition to supplemental oxygen, one of the MOST effective way to minimize the detrimental effects associated with acute coronary syndrome is to: A: reassure the patient and provide prompt transport. B: transport the patient rapidly, using lights and siren. C: administer nitroglycerin in 15 to 20 minute intervals. D: request ALS support for any patient who has chest pain.
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A: reassure the patient and provide prompt transport. Reason: In addition to increasing the body's oxygen supply with supplemental oxygen, it is extremely important to decrease oxygen demand and consumption. You can most effectively accomplish this by keeping the patient calm, providing reassurance, and providing safe, prompt transport to the hospital. Traveling at a high rate of speed with lights flashing and siren blasting would clearly increase the patient's anxiety and the heart's demand for oxygen. The decision to request ALS support is based on the patient's condition and your transport distance to the closest appropriate hospital. Unless contraindicated (ie, the patient is hypotensive, the medication is not prescribed to the patient), nitroglycerin should be given in 5-minute intervals, up to three (3) doses.
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The immobilization device MOST appropriate to use for a patient with multiple injuries and unstable vital signs is the: A: scoop immobilization device. B: short spine board immobilization device. C: long spine board immobilization device. D: vest-style immobilization device.
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C: long spine board immobilization device. Reason: When caring for a critically injured patient with multiple injuries, the patient's entire body should be immobilized. This is most quickly and effectively accomplished using a long spine board. Vest-style devices or short spine boards take too long to apply and will not provide full body immobilization. The scoop (orthopaedic) stretcher is effective for maneuvering patients in narrow spaces but will not allow for full spinal immobilization because of the vertical opening down the center of the device.
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Which of the following statements regarding two-rescuer child CPR is correct? A: The chest should not be allowed to fully recoil in between compressions as this may impair venous return B: A compression to ventilation ratio of 15:2 should be delivered without pauses in compressions to deliver ventilations C: The chest should be compressed with one hand and a compression to ventilation ratio of 30:2 should be delivered D: Compress the chest with one or two hands to a depth that is equal to one third the diameter of the chest
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D: Compress the chest with one or two hands to a depth that is equal to one third the diameter of the chest Reason: When performing two-rescuer CPR on a child (1 year of age to the onset of puberty [12 to 14 years of age]), the chest should be compressed with one or two hands (depending on the size of the child), and a compression to ventilation ratio of 15:2 should be delivered. It is important to compress the chest to an adequate depth—one third the anterior-posterior diameter of the chest (about 1 1/2" in the child). The chest should be allowed to fully recoil in between compressions in order to maximize venous return to the heart. If an advanced airway device (ie, ET tube, multilumen airway, supraglottic airway) is not in place, two rescuers should deliver "cycles" of CPR; the compressor should pause briefly so the ventilator can deliver two breaths. A compression to ventilation ratio of 30:2 is used for one-rescuer child CPR. After an advanced airway device has been inserted, "cycles" of CPR should not be performed; compressions should be continuous at a rate of at least 100/min and ventilations should be delivered at a rate of 8 to 10 breaths/min (one breath every 6 to 8 seconds).
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Shortly after assisting a 60-year-old woman with her second nitroglycerin treatment, she tells you that she is lightheaded and feels like she is going to faint. Her symptoms are MOST likely due to: A: a drop in her blood sugar. B: an irregular heartbeat. C: low blood pressure. D: nervousness and anxiety.
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C: low blood pressure. Reason: Nitroglycerin (NTG) is a vasodilator; as such, it may cause a drop in blood pressure (hypotension) in some patients. Signs and symptoms of hypotension include dizziness, lightheadedness, and fainting (syncope), among others. For this reason, you should always assess a patient's blood pressure before and after administering nitroglycerin. If the patient's systolic BP is less than 100 mm Hg, NTG should not be given. The patient is probably nervous and anxious, and may even have an irregular heartbeat; however, hypotension is a more likely cause of her symptoms. NTG does not affect a patient's blood sugar level.
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You respond to a baseball field for a person who was struck by lightning. When you arrive, you see one patient who appears confused and is ambulatory; a second patient who is conscious, sitting on the ground, and holding his arm; and a third patient who is supine and motionless. After requesting additional responders, you should: A: proceed to the ambulatory patient, sit him down, and assess his mental status. B: assess and begin treating the sitting patient first because he is obviously injured. C: treat the conscious patients because the motionless patient is likely deceased. D: assess the motionless victim and perform CPR and defibrillation if necessary.
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D: assess the motionless victim and perform CPR and defibrillation if necessary. Reason: The process of triaging multiple victims of a lightning strike is different than the conventional triage methods used during a mass-casualty incident. When a person is struck by lightning, respiratory or cardiac arrest, if it occurs, usually occurs immediately. Those who are conscious following a lightning strike are much less likely to develop delayed respiratory or cardiac arrest; they usually survive. Therefore, you should focus your efforts on those who are in respiratory or cardiac arrest. This process, called reverse triage, differs from conventional triage, where such patients would ordinarily be classified as deceased.
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Which of the following is a physiologic effect of epinephrine when used to treat anaphylactic shock? A: As a bronchodilator, it improves the patient's breathing. B: As a vasoconstrictor, it lowers the blood pressure. C: As an antihistamine, it blocks chemicals that cause the reaction. D: As a vasodilator, it increases the blood pressure.
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A: As a bronchodilator, it improves the patient's breathing. Reason: Epinephrine possesses dual effects. As a bronchodilator, it relaxes the smooth muscle of the bronchioles and improves the patient's breathing. As a vasoconstrictor, it constricts the blood vessels and increases the patient's blood pressure. Diphenhydramine (Benadryl) is an antihistamine; it blocks H1 histamine receptor sites, which blocks the release of the chemicals (histamines) that are causing the allergic reaction.
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You are called to a residence for a woman in cardiac arrest. Shortly after starting CPR, the patient's husband presents you with an unsigned document that states "do not attempt resuscitation." You should: A: stop CPR until the document can be validated by a physician. B: contact medical control prior to continuing any resuscitative efforts. C: stop all resuscitative efforts in accordance with the document. D: continue CPR until you have contacted medical control for guidance.
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D: continue CPR until you have contacted medical control for guidance. Reason: Do not attempt resuscitate (DNAR) orders are particularly challenging for EMS providers. When presented with documentation, especially if it does not appear to be valid (in this case, an unsigned document), you should err on the side of patient care and continue resuscitative efforts until medical control orders you to stop.
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You should not attempt to actively rewarm a patient with moderate or severe hypothermia in the field because: A: it is painful for the patient and you cannot give analgesic drugs. B: active rewarming has been shown to cause severe hypertension. C: rewarming too quickly can cause a fatal cardiac dysrhythmia. D: the risk of inadvertently inducing hyperthermia is too high.
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C: rewarming too quickly can cause a fatal cardiac dysrhythmia. Reason: When caring for a patient with hypothermia, your goal is to prevent further heat loss; this involves removing wet clothing, applying warm blankets, and allowing the patient's body temperature to rise gradually and naturally (passive rewarming). If the patient is moderately or severely hypothermic, you should not try to rewarm him or her actively (placing heat on or into the body). Rewarming too quickly may cause a fatal cardiac dysrhythmia, such as ventricular fibrillation (V-Fib). Active rewarming may also cause rewarming shock, a condition in which the blood vessels dilate when heat is applied to the body, resulting in significant hypotension. For these reasons, active rewarming should only be performed in the controlled setting of a hospital.
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The pain associated with acute aortic dissection: A: is typically described as a stabbing or tearing sensation. B: originates in the epigastrium and radiates down both legs. C: typically comes on gradually and progressively worsens. D: is usually preceded by nausea, sweating, and weakness.
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A: is typically described as a stabbing or tearing sensation. Reason: Aortic dissection occurs when the inner layers of the aorta become separated, allowing blood to flow between the layers at high pressure. This separation of layers significantly weakens the aortic wall, making it prone to rupture. Signs and symptoms of acute aortic dissection include a sudden onset of a ripping, tearing, or stabbing pain in the anterior part of the chest or in the back between the scapulae. It may be difficult to differentiate the pain of acute aortic dissection from that of an acute myocardial infarction (AMI), but a number of distinctive features may help. The pain from an AMI is often preceded by other signs and symptoms (ie, nausea, indigestion, weakness, sweating [diaphoresis]). It tends to come on gradually and becomes more severe as time progresses, and is usually described as a crushing pain or as a feeling of heaviness or pressure. By contrast, the pain associated with aortic dissection is acute and is often of maximum intensity from the onset; it is typically described as a ripping, tearing, or stabbing sensation.
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Unresponsiveness, shallow breathing, and constricted pupils are indicative of what type of drug overdose? A: Amphetamine B: Narcotic C: Barbiturate D: Marijuana
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B: Narcotic Reason: Signs of a narcotic (opiate) overdose from drugs such as heroin, morphine (Astromorph, Duramorph), meperidine (Demerol), or codeine include altered mental status; slow, shallow breathing; pupillary constriction (miosis), hypotension; and bradycardia. Narcotics are central nervous system depressants that, when taken in excess, suppress the vital functions necessary for life, such as breathing, heart rate, and blood pressure. Barbiturates produce the same effects; however, the pupils are typically dilated (mydriasis), not constricted. Marijuana and amphetamine drugs are central nervous system stimulants and would thus cause the patient to become restless or even combative.
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A 22-year-old man crashed his motorcycle into a tree. He is found approximately 20 feet away from his bike and is responsive to pain only. He is not wearing a helmet. You are unable to effectively open his airway with the jaw-thrust maneuver. What should you do? A: Insert an oral airway and assess his breathing. B: Carefully tilt his head back and lift up on his chin. C: Apply high-flow oxygen and assess his carotid pulse. D: Suction his oropharynx and reattempt the jaw-thrust.
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B: Carefully tilt his head back and lift up on his chin. Reason: Regardless of the situation, you MUST be able to establish and maintain a patent airway. Without a patent airway, the patient will die. If you are unable to effectively open a trauma patient's airway with the jaw-thrust maneuver, you should carefully perform the head tilt-chin lift maneuver. You cannot assess, not to mention treat, a patient's airway if it is not open and clear of secretions or foreign bodies.
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When is it MOST appropriate to clamp and cut the umbilical cord? A: Before the newborn has taken its first breath B: Immediately following delivery of the newborn C: As soon as the cord has stopped pulsating D: After the placenta has completely delivered
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C: As soon as the cord has stopped pulsating Reason: Generally, it is safe to clamp and cut the umbilical cord once it has stopped pulsating and the baby is breathing adequately. When blood flow through the umbilical cord ceases, it will stop pulsating; this indicates that the baby is oxygenating its own blood. If the cord does not stop pulsating and/or the baby is not breathing adequately, the cord should not be clamped and cut and the baby should be kept at the level of the mother's perineum and managed appropriately while en route to the hospital.
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A 32-year-old man who was stung by a bee has diffuse hives, facial swelling, and difficulty breathing. When he breathes, you hear audible stridor. What does this indicate? A: Swelling of the upper airway structures B: Narrowing of the two mainstem bronchi C: Swelling of the lower airway structures D: Narrowing of the bronchioles in the lungs
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A: Swelling of the upper airway structures Reason: This patient is experiencing a severe allergic reaction (anaphylaxis). Stridor, which is a high-pitched sound heard on inhalation, indicates swelling of the structures and tissues of the upper airway. If not promptly treated, the patient's airway may close completely, resulting in respiratory arrest. Narrowing of the bronchioles in the lungs causes wheezing, a whistling sound that may be heard during inhalation, exhalation, or both.
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When an error occurs while using the AED, it is MOST often the result of: A: malfunction of the microchip inside the AED. B: battery failure secondary to operator error. C: misinterpretation of the patient's cardiac rhythm. D: excess patient movement during the analyze phase.
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B: battery failure secondary to operator error. Reason: AEDs have a high specificity for recognizing shockable rhythm (eg, V-Fib, pulseless V-Tach); this means that they are highly reliable. It would be extremely rare for the AED to recommend a shock when one is not indicated or fail to recommend a shock when one is indicated. When an error does occur, it is usually the operator's fault. The most common error is not having a charged battery. To avoid this problem, many AEDs are equipped with an alarm that warns the operator if the battery is not fully charged. Some of the older AEDs, however, are not equipped with this feature. Therefore, it is important to check the AED daily, exercise the battery as often as the manufacturer recommends, and always have a spare, fully-charged, battery on hand.
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A young male has trauma to multiple body systems after he fell approximately 35 feet. He is semiconscious, has an unstable chest wall, numerous long bone fractures, and a large hematoma to his head. He will have the GREATEST chance for survival if you: A: rapidly transport him to a trauma center. B: keep him warm and elevate his legs. C: request an ALS ambulance. D: give him high-flow oxygen early.
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A: rapidly transport him to a trauma center. Reason: When caring for a patient with major trauma, rapid transport to a trauma center is essential and will afford the patient the best chance for survival. This is especially true if the patient has trauma to multiple body systems. Definitive care cannot be provided in the field; this requires resources and personnel at the hospital. Oxygen administration and shock management (eg, applying blankets, elevating the legs) may help prevent the patient's condition from deteriorating, and although these are important, they are not definitive interventions. In certain situations, it would be prudent to request ALS personnel at the scene (eg, lengthy extrication, unavoidable scene delay); however, in the absence of such extenuating circumstances, it is clearly more important to transport without delay. En route to the trauma center, consider a rendezvous with an ALS unit if it is possible and will not delay transport.
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Which of the following scene size-up findings is LEAST suggestive of an unsafe environment? A: Liquid draining from a car that struck a telephone pole B: Screaming and yelling coming from inside a residence C: The sound of breaking glass as you approach a residence D: A large man standing in his yard awaiting your arrival
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D: A large man standing in his yard awaiting your arrival Reason: When approaching a residence, findings that would suggest an unsafe scene include, among other things, the sound of breaking glass, screaming and yelling, and an unusual silence. Liquid leaking from a wrecked automobile should be assumed to be gasoline and, therefore, dangerous. Although intimidating in appearance, there is no correlation between a person's physical size and his or her potential for violence.
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A prolapsed umbilical cord is dangerous because the: A: cord might pull the placenta from the uterine wall during delivery. B: baby's head may compress the cord, cutting off its supply of oxygen. C: mother may die of hypoxia due to compromised placental blood flow. D: cord may be wrapped around the baby's neck, causing strangulation.
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B: baby's head may compress the cord, cutting off its supply of oxygen. Reason: A prolapsed umbilical cord, a condition in which a portion of the umbilical cord delivers before the baby, is a dangerous condition; the baby's head may compress the cord, cutting off its own supply of oxygen. Therefore, when a prolapsed umbilical cord is discovered, it is important to take immediate action. Place the mother in a position in which her hips are elevated. It may be necessary to insert your gloved fingers into the vagina and lift the baby's head off of the cord. A nuchal cord occurs when the umbilical cord is wrapped around the baby's neck; it is relatively common and is usually easily treated by simply sliding the cord from around the baby's neck. A nuchal cord and a prolapsed umbilical cord usually do not occur at the same time.
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Which of the following airway sounds indicates a lower airway obstruction? A: Crowing B: Stridor C: Wheezing D: Gurgling
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C: Wheezing Reason: Wheezing is a whistling sound that results from narrowing and/or inflammation of the bronchioles in the lungs and is an indicator of a lower airway disease (ie, asthma, bronchiolitis). Crowing and stridor are both high-pitched sounds that indicate an upper airway disease or obstruction (ie, croup, epiglottitis, foreign body obstruction), and gurgling indicates secretions in the oropharynx.
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A 3-year-old boy is found to be in cardiopulmonary arrest. As you begin one-rescuer CPR, your partner prepares the AED. The appropriate compression to ventilation ratio for this child is: A: 15:2 B: 5:1 C: 30:2 D: 3:1
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C: 30:2 Reason: A universal compression to ventilation ratio of 30:2 is used for all one-rescuer CPR (adult, child, and infant), with the exception of the newborn. A compression to ventilation ratio of 3:1 is used for newborns (one- and two-rescuer). Two-rescuer infant and child CPR is performed at a compression to ventilation ratio of 15:2. In this scenario, you are performing one-rescuer CPR as your partner prepares the AED; therefore, you should give 30 compressions and 2 breaths. However, when you and your partner resume CPR, give 15 compressions and 2 breaths.
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You are assessing a 5-year-old boy with major trauma. His blood pressure is 70/40 mm Hg and his pulse rate is 140 beats/min. and weak. The child's blood pressure: A: suggests increased intracranial pressure. B: indicates decompensated shock. C: reflects adequate compensation. D: is appropriate based on his age.
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B: indicates decompensated shock. Reason: The low normal systolic blood pressure (SBP) for a child between 1 and 10 years of age is calculated by multiplying his or her age (in years) by 2 and adding 70. Using this formula, the low normal SBP for a 5-year-old child is 80 mm Hg; anything less indicates hypotension. Therefore, a SBP of 70 mm Hg in a 5-year-old child, especially in the context of major trauma, indicates decompensated shock. Patients with increased intracranial pressure are typically hypertensive, not hypotensive.
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The 5-minute Apgar assessment of a newborn reveals a heart rate of 130 beats/min, cyanosis to the hands and feet, and rapid respirations. The infant cries when you flick the soles of its feet and resists attempts to straighten its legs. These findings equate to an Apgar score of: A: 8 B: 9 C: 10 D: 7
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C: 10 Reason: The Apgar score, which is obtained at 1 and 5 minutes after birth (and every 5 minutes thereafter), assigns numbers (0, 1, or 2) to the following five areas: Appearance, Pulse, Grimace, Activity, and Respirations. A score of 1 is assigned for appearance if the newborn's body is pink, but its hands and feet remain blue. If its heart rate is greater than 100 beats/min, it receives a score of 2 for the pulse. If it cries and tries to move its foot away when soles of its feet are flicked, it is assigned a score of 2 for grimace/irritability. If it resists attempts to straighten its hips and knees, a score of 2 is assigned for activity/muscle tone. If its respirations are rapid, a score of 2 is assigned. Based on these parameters, the newborn in this scenario would receive an Apgar score of 9. Refer to your EMT textbook for a complete review of the Apgar score.
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While triaging patients at a mass-casualty incident, you encounter a responsive middle-aged female with a respiratory rate of 26 breaths/min. What should you do next? A: Assess for bilateral radial pulses B: Assess her ability to follow commands C: Administer high-flow oxygen at once D: Triage her as immediate (red tag)
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A: Assess for bilateral radial pulses Reason: According to the Simple Triage And Rapid Treatment (START) method, if you encounter an adult patient with a respiratory rate that is less than 10 breaths/min or greater than 29 breaths/min, you should triage him or her as immediate (red tag) and move to the next patient. However, if the patient's respiratory rate is between 10 and 29 breaths/min, you should assess his or her hemodynamic status by checking for bilateral radial pulses. If the patient's radial pulses are absent, triage him or her as immediate and move to the next patient. If the patient's radial pulses are present, assess his or her ability to follow simple commands. If the patient is able to follow simple commands, triage him or her as delayed (yellow tag) and move to the next patient. If the patient is unable to follow simple commands, triage him or her as immediate and move to the next patient. Treatment does not occur during the initial triage process.
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You are administering oxygen at 15 L/min to a patient with respiratory distress. If you are using a D cylinder (cylinder constant, 0.16), which reads 1,500 psi, how long will it take before you need to replace the oxygen cylinder? A: 18 minutes B: 9 minutes C: 14 minutes D: 11 minutes
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C: 14 minutes Reason: The length of time you can use an oxygen cylinder depends on the type of cylinder you are using, the pressure in the cylinder, and the oxygen flow rate. A D cylinder is a small oxygen cylinder that is usually carried in the jump kit to the patient; it has a cylinder constant of 0.16. The following method can be used to calculate cylinder duration: gauge pressure (in psi) - the safe residual pressure (200 psi) × the cylinder constant ÷ flow rate in L/min. Using this formula, your D cylinder will become depleted in about 14 minutes, as follows: 1,500 (psi) - 200 (safe residual pressure) × 0.16 (cylinder constant) ÷ 15 (flow rate in L/min) = 13.86 (14 minutes). A full oxygen cylinder should contain 2,000 psi. The safe residual pressure is the lowest acceptable cylinder pressure before it should be replaced; it is usually 200 psi, although some EMS systems use 500 psi as a safe residual pressure. Although you will switch to your on-board oxygen (M cylinder) source when you load the patient into the ambulance, you should always have at least one back-up portable cylinder (preferably two) when administering oxygen to a patient at the scene, especially if you are giving high-flow (12 to 15 L/min) oxygen and/or your on-scene time will be delayed (eg, lengthy extrication, moving a patient from the second floor, etc).
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You are called to the residence of a 39-year-old male with flu-like symptoms. The patient tells you that he has been feeling ill for the last 2 days. He has a fever, headache, and diarrhea, and asks that you take him to the hospital. His blood pressure is 120/60 mm Hg, his pulse is 110 beats/min, and his respirations are 16 breaths/min. You should: A: request an ALS ambulance to the scene to start an IV line. B: ask him if he has a history of HIV infection or hepatitis. C: offer oxygen and transport him in a position of comfort. D: advise him that he can drive himself to his family physician.
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C: offer oxygen and transport him in a position of comfort. Reason: Although the patient is likely experiencing the flu, there are other diseases, some of which are communicable, that can cause similar symptoms. The patient is requesting EMS transport; failure to comply constitutes abandonment. Although he is tachycardic, the remainder of his vital signs are stable; therefore, requesting an ALS ambulance to the scene to start an IV is not necessary. Simply transport him in a position of comfort and offer him supplemental oxygen. If the patient is infected with HIV or hepatitis, he may choose to voluntarily disclose that information. However, to inquire about infection with such diseases is unethical.
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Which of the following statements regarding one-rescuer CPR is correct? A: The chest should be allowed to fully recoil after each compression. B: You should assess the patient for a pulse after 3 cycles of CPR. C: A compression to ventilation ratio of 15:2 should be delivered. D: Ventilations should be delivered over a period of 2 to 3 seconds.
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A: The chest should be allowed to fully recoil after each compression. Reason: When performing CPR on any patient, you should allow the chest to fully recoil after each compression. Incomplete chest recoil causes increased intrathoracic pressure, which may impair blood return to the heart. Assess the patient's pulse after every 5 cycles (about 2 minutes) of CPR; take no longer than 5 to 10 seconds to do this. A compression to ventilation ratio of 30:2 should be performed during all adult and one-rescuer CPR (adult, child, and infant), except for newborns. A compression to ventilation ratio of 15:2 is used during two-rescuer infant and child CPR. Ventilations should be delivered over a period of 1 second each, just enough to produce visible chest rise.
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Firefighters have rescued a man from his burning house. He is conscious and alert, but is experiencing significant respiratory distress. He has a brassy cough and singed nasal hairs. The MOST immediate threat to this patient's life is: A: severe burns. B: hypothermia. C: severe infection. D: airway swelling.
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D: airway swelling. Reason: Because of the patient's signs and symptoms, your must immediate concern should be the potential for swelling and closure of the upper airway; be prepared to assist the patient's ventilations. Signs of upper airway burns include respiratory distress, singed facial and/or nasal hairs, a brassy cough, difficulty breathing, and coughing up sooty sputum. Infection, the burns themselves, and hypothermia should concern you; however, airway problems pose the most immediate life threat.
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You are dispatched to a residence for an elderly female who has possibly suffered a stroke. You find her lying supine in her bed. She is semiconscious; has vomited; and has slow, irregular breathing. You should: A: perform a head tilt-chin lift and insert an oral airway. B: insert a nasal airway and begin assisting her breathing. C: manually open her airway and suction her oropharynx. D: administer high-flow oxygen and place her on her side.
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C: manually open her airway and suction her oropharynx. Reason: This patient's airway is in immediate jeopardy! The first step in caring for any semi- or unconscious patient is to manually open the airway (eg, head tilt-chin lift, jaw-thrust) and ensure it is clear of obstructions or secretions. Because the patient has vomited, she likely has vomitus in her mouth, which must be removed with suction before she aspirates it into her lungs. Mortality increases significantly if aspiration occurs. After opening her airway and removing any vomitus or secretions from her oropharynx with suction, you should insert an airway adjunct (a nasal airway in this case; the patient is semiconscious and likely has an intact gag reflex) and begin assisting her breathing with a bag-mask device. Her respiratory effort is inadequate and should be treated with some form of positive-pressure ventilation, not a nonrebreathing mask. Placing a semi- or unconscious patient on his or her side (recovery position) is only appropriate if he or she is breathing adequately; this patient is not.
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Which of the following would MOST likely cause a rapid drop in a patient's blood glucose level? A: Taking too much prescribed insulin B: Mild exertion after eating a meal C: Eating a meal after taking insulin D: Forgetting to take prescribed insulin
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A: Taking too much prescribed insulin Reason: Compared to diabetic coma (hyperglycemic ketoacidosis, hyperglycemic crisis), insulin shock (hypoglycemia, hypoglycemic crisis) has a rapid onset. It is commonly caused when a patient accidentally takes too much prescribed insulin. Insulin is a fast-acting drug that rapidly causes glucose to exit the bloodstream and enter the cell. Other common causes of hypoglycemia include taking a regular dose of insulin but not eating or taking insulin and exercising heavily. Eating a meal after taking insulin typically does not cause a significant change in the patient's blood glucose level. If a person fails to take his or her insulin, glucose will not be able to enter the cell and will accumulate in the bloodstream (hyperglycemia).
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You arrive at the scene shortly after a 3-year-old female experienced a seizure. The child, who is being held by her mother, is conscious and crying. The mother tells you that her daughter has been ill recently and has a temperature of 102.5°F. What is the MOST appropriate treatment for this child? A: Oxygen via nonrebreathing mask, avoid any measures to lower the child's body temperature, and transport at once. B: Oxygen via the blow-by technique, transport, and request a paramedic intercept so an anticonvulsant drug can be given. C: Oxygen via nonrebreathing mask, place the child in a tub of cold water to lower her body temperature, and transport. D: Oxygen via the blow-by technique, remove clothing to help reduce her fever, and transport with continuous monitoring.
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D: Oxygen via the blow-by technique, remove clothing to help reduce her fever, and transport with continuous monitoring. Reason: As evidenced by her recent illness and fever (102.5°F), this child has likely experienced a febrile seizure. Appropriate treatment for the child following a febrile seizure involves ensuring a patent airway, administering oxygen (the blow-by technique is generally better tolerated in children than a mask), removing the child's clothing to facilitate heat loss, and transporting to the hospital. Avoid cooling the child with water; doing so may cause the child to shiver—a mechanism that produces body heat—which may cause an abrupt rise in body temperature and another seizure. Since the child is no longer seizing, an anticonvulsant drug is not indicated.
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A man was struck in the side of the head with a steel pipe. Blood-tinged fluid is draining from the ear and bruising appears behind the ear. The MOST appropriate treatment for this patient includes: A: controlling the drainage from the ear and immobilizing the entire spine. B: elevating the lower extremities and providing immediate transport. C: applying high-flow oxygen and packing the ear with sterile gauze pads. D: immobilizing the spine, administering oxygen, and monitoring for vomiting.
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D: immobilizing the spine, administering oxygen, and monitoring for vomiting. Patients with significant head injury should be treated by applying high-flow oxygen, assisting ventilations as needed, immobilzing the entire spine, and transporting promptly. Closely monitor the patient for vomiting and be prepared to suction the airway. Elevation of the foot of the spine board may cause more blood to engorge the brain and may increase intracranial pressure (ICP). You should never attempt to control bleeding or fluid drainage from the ears of a patient with a head injury because this too may result in increased ICP. If a patient with an isolated head injury begins showing signs of shock (ie, tachycardia, diaphoresis, tachypnea, hypotension), you should assume that he or she has internal bleeding from another injury and treat accordingly (ie, elevation of the foot-end of the backboard, preventing body heat loss).
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General care for an amputated body part includes: A: wrapping the amputated part in a moist, sterile dressing and keeping it warm. B: thoroughly cleaning the amputated part and wrapping it in a sterile dressing. C: immersing the amputated part in ice cold water to prevent further damage. D: wrapping the amputated part in a moist, sterile dressing and placing it on ice.
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D: wrapping the amputated part in a moist, sterile dressing and placing it on ice. Reason: General care for an amputated body part includes wrapping the part in a moist, sterile dressing and keeping it cool. Placing the wrapped part in a plastic bag and putting it on ice can accomplish this. The amputated part must never be placed directly on ice because this may cause cell and tissue damage. Attempting to clean the amputated part or immersing it directly in water can also cause further cell and tissue damage.
question
A 50-year-old woman with a history of epilepsy is actively seizing. Care for this patient should focus primarily on: A: protecting her from injury and ensuring adequate ventilation. B: placing a bite block in between her molars and giving her oxygen. C: administering high-flow oxygen and requesting an ALS ambulance. D: frequently suctioning her airway and carefully restraining her.
answer
A: protecting her from injury and ensuring adequate ventilation. Reason: Seizure deaths are most frequently the result of hypoxia. When a person is actively seizing, he or she is not breathing adequately. Your primary focus when treating a seizure patient is to protect him or her from injury and to ensure adequate ventilation and oxygenation. Many seizing patients require assisted ventilation. Suction the oropharynx only if the patient has secretions in his or her mouth. Do NOT insert anything into the mouth of a seizing patient; doing so may cause an airway obstruction or damage the soft tissues of the mouth, resulting in bleeding. Do not attempt to restrain an actively seizing patient; doing so may result in musculoskeletal injuries. Request an ALS ambulance per your local protocols.
question
In which position should you place an uninjured, unresponsive patient with a respiratory rate of 14 breaths/min and adequate tidal volume? A: Semi-Fowler's B: Supine C: Lateral recumbent D: Full-Fowler's
answer
C: Lateral recumbent Reason: The recovery position, which involves placing the patient on his or her side (lateral recumbent), is used to maintain a patent airway in an unresponsive patient who is not injured AND is breathing on his or her own with a normal rate and adequate tidal volume (depth of breathing). Patients who are in shock or require positive-pressure ventilation should be placed in a supine (on his or her back) position. The semi-Fowler's position involves placing the patient in a semisitting position at a 45-degree angle; it is the position of comfort for most patients. The full-Fowler's position involves sitting the patient in an upright position at a 90-degree angle; it is often used for patients with respiratory distress.
question
A 60-year-old woman is experiencing severe respiratory distress. When you ask her a question, she can only say two words at a time. Treatment for her should include: A: assisted ventilation with a bag-mask device. B: insertion of a nasopharyngeal airway. C: applying a nonrebreathing mask set at 15 L/min. D: applying a nasal cannula set at 2 to 6 L/min.
answer
A: assisted ventilation with a bag-mask device. Reason: Because the patient is only able to speak in minimal word sentences (two-word dyspnea) and is experiencing severe respiratory distress, it is unlikely that she is ventilating adequately. Therefore, you should assist her ventilations with a bag-mask device. If her breathing continues as it is, she will become increasingly hypoxic and may lose consciousness. Because this patient is conscious, you must explain to her that every time she takes in a breath, the bag-mask device will be squeezed so that an adequate volume of air can be delivered. Clearly, this can cause the patient great anxiety, so your reassurance during this procedure is important. If the patient will not tolerate your attempts to assist her ventilations, apply a nonrebreathing mask and monitor her closely.
question
You are called to a local park for a 7-year-old boy with respiratory distress. During your assessment, you find that the patient is wheezing and has widespread hives and facial edema. What should you suspect has occurred? A: Poison oak exposure B: Allergic reaction C: Acute asthma attack D: Heat illness
answer
B: Allergic reaction Reason: Wheezing, hives, and edema are hallmark findings of an allergic reaction. In this case, the patient is having a severe reaction. Although wheezing occurs in patients with asthma, hives and facial edema do not. Wheezing is not associated with head-related illnesses. Exposure to poison oak or poison ivy causes a local reaction, such as redness and itching or burning; it is not commonly associated with systemic symptoms.
question
The automated external defibrillator (AED) should NOT be used in patients who: A: are between 1 and 8 years of age. B: experienced a witnessed cardiac arrest. C: have a nitroglycerin patch applied to the skin. D: are apneic and have a weak carotid pulse.
answer
D: are apneic and have a weak carotid pulse. Reason: The AED is only applied to patients in cardiac arrest (eg, pulseless and apneic), whether the arrest was witnessed or unwitnessed. According to the 2010 guidelines for CPR and Emergency Cardiac Care (ECC), AEDs can safely be used in infants and children less than 8 years of age in conjunction with a dose-attenuating system (energy reducer) and pediatric pads. However, if pediatric pads and an energy reducer are unavailable, adult AED pads should be used. A nitroglycerin patch is not a contraindication to the use of an AED; simply remove the patch (with gloved hands) and apply the AED as usual.
question
You arrive at the scene where a man fell approximately 40 feet and landed on his head. He is unresponsive, has agonal gasps, and a weak carotid pulse. Further assessment reveals an open head injury with exposed brain matter. Upon identifying this patient as an organ donor, you should: A: manage the patient aggressively and provide rapid transport. B: provide rapid transport only because the patient likely will not survive. C: request authorization from medical control not to initiate care. D: recognize that the patient's injuries disqualify him as an organ donor.
answer
A: manage the patient aggressively and provide rapid transport. Reason: It is unlikely that the patient will survive his injury; however, he is still breathing, albeit very poorly, and has a weak carotid pulse. Therefore, you should begin immediate and aggressive treatment and transport him promptly, just as you would for any other critically injured patient. It would clearly be inappropriate to request authorization to provide no care at all. If it is determined by a physician that he will not survive his injury, his organs can potentially be harvested and save several lives.
question
A 60-year-old man is in cardiac arrest. You begin CPR while your partner applies the AED. What should you do if you receive a no shock message? A: Ensure that the AED electrodes are properly applied. B: Assess for a carotid pulse for up to 10 seconds. C: Reanalyze his cardiac rhythm after 30 seconds of CPR. D: Resume CPR, starting with chest compressions.
answer
D: Resume CPR, starting with chest compressions. Reason: If the AED gives a no shock advised message, you should immediately resume CPR, starting with chest compressions. After 2 minutes of CPR, reanalyze the patient's cardiac rhythm and follow the AED voice prompts. You should not assess for a pulse if the AED gives a no shock message; this will only cause an unnecessary delay in performing chest compressions. Rarely, if ever, does CPR alone restore a normal cardiac rhythm and pulse. If the AED electrodes are improperly applied, it will not analyze the patient's cardiac rhythm; instead, you will receive a "check patient" or "check electrodes" message. Continue CPR, rhythm analysis every 2 minutes, and defibrillation (if indicated) until ALS personnel arrive or the patient starts to move.
question
You are cleaning the back of the ambulance after transporting a patient with major trauma. Which of the following contaminated items should NOT be placed in a plastic biohazard bag? A: Suction canister B: Blood-soaked gauze pads C: Rigid suction catheter D: Plastic IV catheter
answer
D: Plastic IV catheter Reason: Contrary to popular belief, the end of a Teflon IV catheter (the plastic catheter without the needle) can cut you; it is sharp! Therefore, it should be placed in a puncture-proof sharps container, not a plastic biohazard bag. Items that are blood-soaked or are otherwise contaminated, but cannot puncture, can safely be placed in a plastic biohazard bag.
question
You have just delivered a baby girl. Your assessment of the newborn reveals that she has a patent airway, is breathing adequately, and has a heart rate of 130 beats/min. Her face and trunk are pink, but her hands and feet are cyanotic. You have clamped and cut the umbilical cord, but the placenta has not yet delivered. You should: A: give the newborn high-flow oxygen via a nonrebreathing mask and transport. B: keep the newborn warm, give oxygen to the mother if needed, and transport. C: reassess the newborn every 5 minutes and transport after the placenta delivers. D: massage the lower part of the mother's uterus until the placenta delivers.
answer
B: keep the newborn warm, give oxygen to the mother if needed, and transport. Reason: The newborn is stable and does not require care beyond providing thermal management and monitoring. Oxygen is indicated for the newborn if it has central cyanosis (cyanosis to the face and trunk), and should be delivered via the blow-by technique with the flowmeter set at 5 L/min. Cyanosis to the periphery of the body (eg, hands and feet), which is called acrocyanosis, is a normal finding in the newborn. You should not wait at the scene for the placenta to deliver; it can take up to 45 minutes for this to occur. Begin transport, keep the newborn warm, and give oxygen to the mother if indicated. Massaging the uterine fundus (top part of the uterus) is indicated for women with postpartum vaginal bleeding (ie, BOTH the baby and placenta have delivered).
question
A patient who overdosed on heroin would be expected to present with: A: dilated pupils. B: hypotension. C: hyperpnea. D: tachycardia.
answer
B: hypotension. Reason: Heroin is a Schedule I (illegal) narcotic that is typically injected. As with all narcotics, legal or illegal, overdose causes depression of the central nervous system (CNS), resulting in a decreased level of consciousness; bradycardia; hypotension; and slow, shallow (reduced tidal volume) breathing. Hyperpnea (deep breathing) would not be present in a patient who overdosed on a narcotic. In a narcotic overdose, the pupils are typically constricted (miosis). Barbiturates, such as phenobarbital, are also CNS depressants and cause the same symptoms seen with narcotic overdose. The patient's pupils, however, are typically dilated (mydriasis), not constricted.
question
A 40-year-old man was hit in the nose during a fight. He has bruising under his left eye and a nosebleed. After taking standard precautions, you should: A: apply direct pressure by pinching his nostrils together. B: determine if he has any visual disturbances. C: place a chemical icepack over his nose. D: ensure that he is sitting up and leaning forward.
answer
D: ensure that he is sitting up and leaning forward. Reason: During a nosebleed (epistaxis), much of the blood may pass down the throat into the stomach as the patient swallows; this is especially true if the patient is lying supine. Blood is a gastric irritant; a person who swallows a large amount of blood may become nauseated and vomit, which increases the risk of aspiration. Therefore, your first action should be to ensure that the patient is sitting up and leaning forward. This will prevent blood from draining down the back of the throat. Next, apply direct pressure by pinching the fleshy part of the nostrils together; you or the patient may do this. Placing a chemical icepack over the nose may further help control the bleeding by constricting the nasal vasculature. After controlling the nosebleed, continue your assessment, which includes assessing for facial deformities and visual disturbances.
question
Which of the following actions demonstrates an EMT's knowledge of crime scene preservation? A: Placing a knife in a plastic zip-lock bag and giving it to a law enforcement officer for safe-keeping B: Carefully cutting through the hole in a patient's clothing that was made by a large caliber firearm C: Advising a law enforcement officer after moving a coffee table to access a critically injured patient D: Requesting approval from law enforcement before controlling severe bleeding from a patient's arm
answer
C: Advising a law enforcement officer after moving a coffee table to access a critically injured patient Reason: After ensuring your own safety, your priority when caring for a patient at a crime scene is to do just that, care for the patient. If you need to move a piece of furniture to gain access to a critically injured patient, move the furniture, treat the patient, and then advise a law enforcement officer of what you moved and where you moved it to. In this way, you are providing immediate care to the patient, but are remaining aware that the location of any obstacles between you and the patient may serve as evidence. Clearly, you are not going to request approval from a law enforcement officer before treating a critically injured patient. Items that may have fingerprints on them, such as knives or guns, should be placed in a paper bag; condensation can accumulate in plastic bags, potentially destroying any evidence. When removing clothing from a gunshot victim, you should make an effort to cut around (not through) the hole in the clothing that was made by the bullet. The hole in a patient's clothing may contain gunshot residue and can provide valuable information regarding the type of weapon used and the distance between the assailant and the victim.
question
During a soccer game, a 20-year-old man collided shoulder-to-shoulder with another player. He has pain and a noticeable anterior bulge to the left shoulder. Which of the following is the MOST effective method of immobilizing this injury? A: A sling to support the left arm and swathes to secure the arm to the body B: A long board splint with the left arm immobilized in the extended position C: An air-inflatable splint with the left arm immobilized in the flexed position D: A sling to support the left arm and swathes to maintain downward traction
answer
A: A sling to support the left arm and swathes to secure the arm to the body Reason: Injuries to the shoulder are most effectively immobilized with the use of a sling and swathe. The sling will provide support and relieve pain to the shoulder, and the swathe will secure the arm to the body. The purpose of the swathe is not to facilitate traction. Patients with dislocated or fractured shoulders will not allow you to extend their arm, so any attempt to immobilize the injury in such a fashion will not be possible and could worsen the injury.
question
After arriving at a mass-casualty incident where other ambulances are already present, you should notify the dispatcher and then: A: initiate care for the most critically injured patients. B: repeat the triage process. C: obtain information from the fire service commander. D: report to the staging area.
answer
D: report to the staging area. Reason: Once you arrive at the scene of a mass-casualty incident where an incident command system has already been established, you should report to the staging area, the area designated for all incoming ambulances and resources. The staging officer will know where help is needed the most and will be able to direct your actions accordingly.
question
Treatment for a responsive 4-year-old child with a mild airway obstruction, who has respiratory distress, a strong cough, and normal skin color, includes: A: subdiaphragmatic thrusts until the object is expelled. B: oxygen, back slaps, and transport. C: supplemental oxygen and transport. D: assisted ventilations, back slaps, and transport.
answer
C: supplemental oxygen and transport. Reason: If a child (1 year of age to the onset of puberty [12 to 14 years of age]) with a mild airway obstruction is alert and has adequate air movement (ie, a strong cough, normal skin color), you should offer oxygen, avoid agitating the child, and provide transport to the hospital. Attempts to relieve a mild airway obstruction may result in a severe airway obstruction. If signs of a severe airway obstruction develop, you must take immediate action to remove the object (eg, back slaps and chest thrusts in a responsive infant; subdiaphragmatic [abdominal] thrusts in a responsive adult or child). Finger sweeps are ONLY indicated if the patient is unresponsive and you can see the object in his or her mouth.
question
The energy setting for a biphasic AED: A: must be manually set by the EMT. B: increases by 50 joules with each shock. C: is manufacturer specific. D: is typically 360 joules.
answer
C: is manufacturer specific. Reason: A biphasic AED sends energy in two directions simultaneously. This is advantageous because it produces a more efficient defibrillation than monophasic defibrillation, which sends energy in only one direction, and uses a lower energy setting. The energy setting on a biphasic AED is device specific, but typically ranges from 120 to 200 joules. AEDs are preprogrammed by the manufacturer to deliver a specific amount of energy, which eliminates the need to manually set the energy level. Some biphasic AEDs deliver the same amount of energy for each shock; others may escalate the energy level for each shock. Refer to the manufacturer's documentation that accompanies the AED you use regarding the amount of biphasic energy it delivers.
question
Which of the following signs or symptoms is MOST suggestive of a systemic reaction following ingestion of a poison? A: Painful or difficult swallowing B: Burns around the mouth C: Nausea and vomiting D: Tachycardia and hypotension
answer
D: Tachycardia and hypotension Reason: Once an ingested poison gets into the system, it can affect multiple organ systems. Signs that this is occurring include tachycardia or bradycardia, hypotension or hypertension, weakness, restlessness, and an altered level of consciousness, among others. Local effects of an ingested poison include nausea and vomiting as the poison irritates the gastric lining, burns in and around the mouth, and painful or difficult swallowing (dysphagia).
question
Which of the following patients has the highest priority at the scene of a mass-casualty incident? A: 35-year-old unresponsive woman with snoring respirations and severe burns B: 38-year-old woman who remains apneic after you manually open her airway C: 44-year-old unresponsive man with an open head injury and agonal gasps D: 29-year-old man who is pulseless and apneic with an abdominal evisceration
answer
A: 35-year-old unresponsive woman with snoring respirations and severe burns Reason: The goal of triage is to provide the greatest good for the greatest number of people. Relative to the other patients, who are either in respiratory or cardiac arrest or have injuries incompatible with life, the woman with snoring respirations and severe burns has the best chance for survival. Therefore, she has the highest treatment priority.
question
Nitroglycerin is contraindicated in all of the following situations, EXCEPT: A: the presence of a head injury. B: history of cardiac bypass surgery. C: systolic BP of 80 mm Hg. D: recent use of Cialis.
answer
B: history of cardiac bypass surgery. Reason: Nitroglycerin (NTG) is a vasodilator drug used to relieve chest pain in patients with cardiac compromise by dilating the coronary arteries and improving blood flow to the heart. Because of its vasodilator effects, it should not be given to patients who have a systolic BP less than 100 mm Hg or to patients who have recently (within the past 24 to 48 hours) taken erectile dysfunction (ED) drugs (eg, sildenafil [Viagra], vardenafil [Levitra], tadalafil [Cialis]). ED drugs also cause vasodilation and may cause significant hypotension if given together with NTG. You should also avoid NTG in patients with a head injury; dilation of the cerebral blood vessels may worsen intracranial pressure caused by the head injury. By itself, a history of cardiac bypass surgery does not contraindicate the use of NTG.
question
When you arrive at a residence for a man who is "not acting right," you enter the house and find him sitting on his couch. Which of the following findings would be MOST indicative of an altered mental status? A: Slurred speech. B: Eyes are closed. C: Odor of alcohol. D: Tired appearance.
answer
A: Slurred speech. Reason: Often, an altered mental status can be difficult to assess, especially if you do not know how the patient normally acts. However, there are key findings that should increase your index of suspicion. An abnormal speech pattern, such as slurring or incoherent words, can be the result of a diabetic problem, alcohol intoxication, or drug ingestion. All of these can cause an altered mental status. The odor of alcohol suggests intoxication as a potential cause of his problem, but cannot be quantified. Just because the patient's eyes or closed or he has a tired appearance does not necessarily indicate that he has an altered mental status.
question
When caring for a trauma patient with signs of intraabdominal bleeding, it is MOST important for the EMT to: A: transport rapidly to an appropriate medical facility. B: apply and inflate the pneumatic antishock garment. C: perform an in-depth abdominal assessment. D: auscultate bowel sounds for at least 2 minutes.
answer
A: transport rapidly to an appropriate medical facility. Reason: Your priority for a trauma patient with signs of intraabdominal bleeding (eg, abdominal rigidity, distention), or any internal bleeding for that matter, is to rapidly transport to an appropriate medical facility, such as a trauma center. It does not matter where the source of the bleeding is; it does matter that you cannot control the bleeding in the field. The patient requires surgery. An in-depth abdominal assessment is not required to determine the presence of intraabdominal bleeding, and auscultating bowel sounds is impractical and will provide you with little, if any, additional information. The PASG is indicated only for use as a splint to stabilize pelvic or bilateral femur fractures; it should not be applied to patients with abdominal, chest, or head trauma.
question
You receive a call for a 54-year-old female who is having a seizure. When you arrive at the scene, the patient is actively seizing. Her husband tells you that she has a history of seizures, and that she has been seizing continuously for 20 minutes. It is MOST important for you to recognize that: A: the patient is hypoxic and needs oxygen as soon as possible. B: her husband's description is consistent with status epilepticus. C: the patient may have stopped taking her seizure medication. D: her seizure could be the result of a low blood glucose level.
answer
A: the patient is hypoxic and needs oxygen as soon as possible. Reason: There are many causes of seizures, including noncompliance with prescribed anticonvulsant medications, hypoglycemia, stroke, head trauma, and poisoning, among others. Regardless of the underlying cause, it is most important to recognize that patients who are actively seizing, especially if the seizure is prolonged, are hypoxic and need high-flow oxygen as soon as possible; in many cases, it may be necessary to assist the patient's ventilations. The husband's description of the seizure (eg, continuous for 20 minutes) is consistent with status epilepticus, which is all the more reason to recognize that she is severely hypoxic. Seizure-related deaths are the result of cerebral hypoxia.
question
The purpose of the pediatric assessment triangle is to: A: form a general impression of the child without touching him or her. B: identify if the child has a medical condition or a traumatic injury. C: detect immediate life threats through a quick hands-on assessment. D: determine if the child's problem is respiratory or circulatory in nature.
answer
A: form a general impression of the child without touching him or her. Reason: The pediatric assessment triangle (PAT) is a structured assessment tool that allows you to rapidly form a general impression of the infant's or child's condition without touching him or her. The intent is to provide a "first glance" assessment to identify the general category of the child's physiologic problem and to establish urgency for treatment and/or transport. The PAT is a visual assessment of the child before performing a hands-on assessment; it consists of three elements: appearance (muscle tone and mental status), work of breathing, and circulation to the skin. The only equipment required for the PAT are your own eyes and ears.
question
The preferred method for inserting an oropharyngeal airway in a small child is to: A: insert the airway with the curvature towards the roof of the mouth and then rotate it 180 degrees. B: open the airway with the tongue-jaw lift maneuver and insert the airway until you meet slight resistance. C: insert the airway as you would in an adult, but use an airway that is one size smaller than you would normally use. D: depress the tongue with a tongue blade and insert the airway with the downward curve facing the tongue.
answer
A: insert the airway with the curvature towards the roof of the mouth and then rotate it 180 degrees. Reason: Keeping in mind that a child's tongue is proportionately large, the preferred method for inserting an oropharyngeal (oral) airway is to use a tongue blade to depress the tongue and slide the airway straight in, with the downward curve of the airway facing the tongue, until it rests just beyond the curvature of the tongue. If you use an oral airway that is too small, it will not reach the curvature of the tongue and propel it forward. If you use an oral airway that is too large, it may obstruct the airway. If you meet resistance when inserting an oral airway, you are likely using an airway that is too large.
question
A 60-year-old man presents with a severe right-sided headache. He is conscious and alert. As you are assessing him, he tells you that the left side of his body feels weak. His blood pressure is 190/100 mm Hg, pulse is 88 beats/min, and respirations are 14 breaths/min. His past medical history includes diabetes, arthritis, and hypertension. You should be MOST concerned with: A: his current blood pressure. B: the presence of hemiparesis. C: his blood glucose level. D: the location of his headache.
answer
B: the presence of hemiparesis. Reason: Headaches are a common medical complaint and have numerous causes, most of which are not life-threatening. Common causes of a headache include migraine and cluster headaches, sinusitis, and muscle tension, among others. In some patients, however, a headache can signal a serious problem. In this patient, you should be most concerned with his unilateral weakness (hemiparesis); this is not a common finding in patients with otherwise benign headaches and suggests a serious underlying problem (eg, intracranial bleeding, brain tumor). The fact that his headache is to the right side of his head and his weakness is to the left side of his body suggests that the problem lies in the right side of the brain. It is doubtful that his blood glucose level (BGL) is abnormal; he is conscious and alert. However, it would not be unreasonable to assess his BGL. His blood pressure, which is significantly elevated, could be causing his headache or may be the result of other factors, such as noncompliance with his antihypertensive medication, anxiety, or pain.
question
A 22-year-old female fell on her knee and is in severe pain. Her knee is flexed and severely deformed. Her leg is cold to the touch and you are unable to palpate a distal pulse. You should: A: manually stabilize her injury and contact medical control for further stabilization instructions. B: place a pillow behind her knee and stabilize the injury by applying padded board splints. C: apply gentle longitudinal traction as you straighten her leg and then apply a traction splint. D: carefully straighten her leg until you restore a distal pulse and then apply padded board splints.
answer
A: manually stabilize her injury and contact medical control for further stabilization instructions. Reason: A dislocated knee occurs when the proximal end of the tibia completely displaces from its juncture with the distal femur. In some cases, the popliteal artery behind the knee may be compressed, resulting in compromised distal blood flow. Signs of this include absent distal pulses and a pale extremity that is cool or cold. Manually stabilize the knee and assess for distal pulses. If distal pulses are absent, contact medical control immediately for further stabilization instructions. Medical control may instruct you to make ONE attempt to realign the knee to reduce compression of the popliteal artery and restore distal circulation. If you are unable to restore distal circulation or medical control advises you not to manipulate the injury, splint the knee in the position it was found and transport promptly. Traction splints are contraindicated in any injury to or near the knee.
question
During your assessment of a woman in labor, you see the baby's arm protruding from the vagina. The mother tells you that she needs to push. You should: A: insert your gloved fingers into the vagina and try to turn the baby. B: gently push the protruding arm back into the vagina. C: encourage the mother to push and give her high-flow oxygen. D: cover the arm with a sterile towel and transport immediately.
answer
D: cover the arm with a sterile towel and transport immediately. Reason: On rare occasions, the presenting part of the fetus is neither the head nor buttocks, but a single arm or leg. This is called a limb presentation. You cannot successfully deliver such a presentation in the field. These infants usually must be delivered surgically. If you encounter a limb presentation, transport immediately. Cover the protruding limb with a sterile towel. If the mother feels the urge to push, you should discourage this; pushing may put pressure on the fetus, potentially causing injury. Never try to push the limb back in, and never pull on it. Place the mother on her back, with head down and pelvis elevated. Because both mother and fetus are likely to by physically stressed in this situation, give the mother high-flow oxygen.
question
Which of the following vaccinations is NOT currently recommended by the Centers for Disease Control and Prevention (CDC)? A: Tetanus, diphtheria, and pertussis B: Smallpox C: Measles, mumps, rubella D: Hepatitis B
answer
B: Smallpox Reason: Immunization requirements are usually set by the state department of health, but generally follow recommendations made by the Centers for Disease Control and Prevention (CDC). Recommended immunizations for health care providers include tetanus, diphtheria, and pertussis (Tdap, DTaP) boosters (every 10 years); measles, mumps, rubella (MMR) booster; influenza vaccine (yearly); and hepatitis B vaccine (single or three-shot series). Smallpox vaccinations ceased in 1972 after the World Health Organization (WHO) officially declared the disease eradicated.
question
As you step out of the ambulance at the scene of a nighttime motor vehicle crash on the highway, your MOST immediate concern should be: A: rapid assessment of all injured patients. B: the presence of oncoming traffic. C: placing safety flares by the ambulance. D: whether the car will catch on fire.
answer
B: the presence of oncoming traffic. Reason: Nighttime traffic crashes, especially those that occur on a highway, pose a significant risk to the safety of the EMT. Therefore, immediately upon exiting the ambulance, the concern for oncoming traffic should be at the front of the EMT's mind. Drivers can be blinded by all of the emergency lighting and inadvertently veer off of the road and strike the rescuer. Safety flares are used less commonly than in the past; they have been known to blow off the road and start grass fires or ignite gasoline leaking from a vehicle. Reflective cones or triangles are safer and are used more often than flares. After ensuring your own safety, which includes notifying the fire department if the vehicle is leaking gas, you should then proceed to the patients.
question
Shock following major trauma is MOST often the result of: A: head injury. B: spinal injury. C: hemorrhage. D: long bone fractures.
answer
C: hemorrhage. Reason: Shock following major trauma is usually caused by hemorrhage (bleeding), which can be external and obvious (gross), internal and hidden (occult), or both. Trauma to the chest and/or abdomen and multiple long bone fractures are common causes of hemorrhage that result in shock. An isolated head injury usually does not cause shock; it causes increased intracranial pressure. If the patient with a seemingly isolated head injury has signs of shock, look for other injuries. Major trauma may also be associated with spinal injury. If the spinal cord is injured, the patient may develop shock because the nerves that control the diameter of the blood vessels are damaged, resulting in widespread vasodilation (neurogenic shock).
question
Which of the following patients with diabetes is the BEST candidate for oral glucose? A: A confused patient who has cool, clammy skin B: A confused patient with suspected hyperglycemia C: A semiconscious patient with pale, clammy skin D: An unresponsive patient who took too much insulin
answer
A: A confused patient who has cool, clammy skin Reason: Oral glucose is indicated for patients with diabetes who are in insulin shock (hypoglycemic crisis), or for any patient with symptomatic hypoglycemia (as documented by glucometer). The patient must be conscious and alert enough to be able to swallow the glucose, which comes in a tube of gel. If the patient is unresponsive or otherwise unable to swallow the glucose, you should provide rapid transport, providing the appropriate airway management en route, and consider an ALS intercept.
question
The MAIN reason why small children should ride in the backseat of a vehicle is because: A: the back of the front seat will provide a cushion during a crash. B: they are much less likely to be ejected from the vehicle. C: they can experience severe injury or death if the airbag deploys. D: their legs are highly prone to injury from striking the dashboard.
answer
C: they can experience severe injury or death if the airbag deploys. Reason: Children under 12 years of age should ride in the backseat of a vehicle, preferably in the middle, and restrained in a device that is appropriate for their size. Merely placing the child in the backseat does not reduce the risk of ejection; the child must be properly restrained. Young children, especially those restrained in a child safety seat, may be critically injured or killed by airbags if they are riding in the front passenger seat of a car. This occurs because the child safety seat positions the child too close to the airbag; the force of the deploying airbag may cause severe head and spinal trauma.
question
A 30-year-old woman is 22 weeks pregnant with her first child. She tells you that her rings are not fitting as loosely as they usually do and that her ankles are swollen. Her blood pressure is 150/86 mm Hg. She is MOST likely experiencing: A: gestational diabetes. B: a hypertensive emergency. C: a condition unrelated to pregnancy. D: preeclampsia.
answer
D: preeclampsia. Reason: Preeclampsia typically develops after the twentieth week of gestation; it most commonly occurs in primigravida (first-time pregnancy) women. Preeclampsia is characterized by a headache, visual disturbances, edema to the hands and feet, anxiety, and persistent hypertension. Left untreated, preeclampsia can lead to seizures (eclampsia). Gestational diabetes, a condition in which the pregnancy hormones estrogen and progesterone impair the effects of insulin (insulin resistance), is characterized by an increase in the patient's blood glucose level (BGL); there is no mention of the patient's BGL in this scenario. A hypertensive emergency usually occurs when the systolic blood pressure acutely rises above 160 mm Hg.
question
Tachycardia can be detrimental to a patient who is experiencing a cardiac problem because it causes: A: an associated increase in breathing difficulty. B: a profound decrease in oxygen consumption. C: increased cardiac filling in between beats. D: increased cardiac oxygen usage and demand.
answer
D: increased cardiac oxygen usage and demand. Reason: Many patients experiencing a cardiac problem are tachycardic (heart rate greater than 100 beats/min); others are bradycardic (heart rate less than 60 beats/min). As the heart beats faster, it consumes, and therefore requires, more oxygen. This can be detrimental to the patient because the heart is already deprived of oxygen (ischemia) and may not be able to accommodate the increased need for oxygen; this may worsen the ischemia, potentially causing further cardiac damage. A very fast heart rate (>150 beats/min) may cause hypotension due to a decrease in cardiac output; it occurs because the ventricles are not adequately filling with blood in between beats. Some patients with a cardiac problem may have difficulty breathing, which may be the result of congestive heart failure and pulmonary edema; it is not caused by the tachycardia itself.
question
Prior to your arrival at the scene, a young female was removed from the water after being submerged for an unknown period of time. You should manage her airway appropriately while considering the possibility of: A: airway obstruction. B: hyperthermia. C: spinal injury. D: internal bleeding.
answer
C: spinal injury. Reason: When caring for a patient with a submersion injury (ie, near-drowning), you should consider the possibility of a spinal injury. Many water-related incidents occur when a patient dives into shallow water and strikes his or her head. Water can be aspirated into the lungs, but will not cause an obstruction of the upper airway. Another common finding in patients with a submersion injury is hypothermia. Although it is possible for the patient to have internal bleeding at the same time, especially if he or she experienced a traumatic injury before the submersion, spinal injuries are more common.
question
Which of the following techniques represents the MOST appropriate method of opening the airway of an infant with no suspected neck injury? A: Tilt the head back without hyperextending the neck. B: Gently lift the chin while maintaining slight flexion of the neck. C: Perform the technique as you would for an older child or adult. D: Lift up the chin and hyperextend the neck.
answer
A: Tilt the head back without hyperextending the neck. Reason: Opening the airway in infants and small children involves keeping the head in a neutral or slightly extended position. Because the occipital region (back of the head) of the skull is proportionately larger in infants and small children when compared to an adult, hyperextension of the neck can result in a reverse flexion of the neck and subsequent airway blockage.
question
Which of the following is the MOST detrimental effect that tachycardia can have on a patient experiencing a cardiac problem? A: Increased stress and anxiety B: Increased blood pressure C: Decreased cardiac functioning D: Increased oxygen demand
answer
D: Increased oxygen demand Reason: As the heart beats faster, it consumes and demands more oxygen. Tachycardia can be extremely detrimental to the patient with a compromised heart that is already deprived of oxygen. Keeping the patient calm cannot be overemphasized. The more stressed and anxious the patient gets, the faster his or her heart will beat.
question
Your partner, a veteran EMT of 20 years, has been showing up late to work with increasing frequency over the last several shifts. When he arrives, he is in a bad mood and is clearly not interested in being at work. His behavior is MOST consistent with: A: burnout. B: delirium. C: acute stress. D: drug use.
answer
A: burnout. Reason: Your partner's behavior is consistent with burnout. Burnout is a condition of chronic fatigue, irritability, and frustration that results from mounting stress over time. Although burnout typically manifests after years of service in EMS, some EMTs begin to experience it in a very short period of time, especially if they work in EMS systems with a high call volume and low morale. Some people with burnout abuse drugs or alcohol; if you suspect this, you should report it to your supervisor immediately. The best way to prevent burnout is to recognize the signs of stress and take action to reduce it. An acute stress reaction occurs in response to a sudden, unexpected event; it is clear that your partner has had many stressful events over his career. Delirium is an acute change in cognitive ability; it commonly results from conditions such as hypoxia, hypoglycemia, and drug toxicity.
question
An unresponsive patient with multi-systems trauma has slow, shallow breathing; weak radial pulses; and severe bleeding from a lower extremity wound. You should direct your partner to: A: prepare the long spine board and straps for rapid spinal immobilization. B: radio for a paramedic ambulance to respond to the scene. C: assist the patient's ventilations while you control the bleeding. D: apply oxygen via nonrebreathing mask while you control the bleeding.
answer
C: assist the patient's ventilations while you control the bleeding. Reason: The goal of the primary assessment is to rapidly identify and correct all life-threatening injuries or conditions. In the case of this patient, as your partner maintains in-line cervical spine control, he or she should assist the patient's ventilations. An unresponsive patient with slow, shallow breathing is not breathing adequately and should be treated with ventilatory assistance, not a nonrebreathing mask. As your partner is managing the patient's airway and providing ventilatory assistance, you should apply direct pressure (or a tourniquet, if needed) to the extremity wound to control the bleeding. It is important for you and your partner to work together so that all life-threats can be corrected as soon as possible. Most EMS systems work with two-person crews and do not have the luxury of a third EMT. If the police or fire department is on the scene, you can ask them to gather equipment for you. The request for an ALS ambulance is based on factors such as the patient's condition and transport time to the closest appropriate hospital.
question
The MOST appropriate treatment for a semiconscious patient with slow, shallow respirations includes: A: an oropharyngeal airway and assisted ventilation with a bag-mask device. B: a nasopharyngeal airway and high-flow oxygen via a nonrebreathing mask. C: an oropharyngeal airway and high-flow oxygen via a nonrebreathing mask. D: a nasopharyngeal airway and assisted ventilation with a bag-mask device.
answer
D: a nasopharyngeal airway and assisted ventilation with a bag-mask device. Reason: Semiconscious patients are not fully able to protect their own airway and require an airway adjunct. The nasopharyngeal airway is indicated for semiconscious patients because they often have an intact gag reflex; the oropharyngeal airway is contraindicated in any patient with an intact gag reflex. Slow, shallow respirations will not provide the minute volume needed to support adequate oxygenation and should be treated with positive-pressure ventilation assistance (eg, bag-mask device, pocket face mask).
question
A 50-year-old man presents with crushing chest pain of sudden onset. He is diaphoretic, apprehensive, and tachypneic. You should: A: apply supplemental oxygen. B: obtain baseline vital signs. C: ask him if he takes nitroglycerin. D: perform a complete physical exam.
answer
A: apply supplemental oxygen. Reason: All of the interventions and assessments listed in this question should be performed on a patient who presents with chest pain, pressure, or discomfort. However, supplemental oxygen is indicated for any patient with a potential cardiac problem and should be given as soon as possible; this is especially true when the patient has potential respiratory involvement as well (ie, dyspnea, tachypnea). Administer oxygen in a concentration sufficient to maintain an oxygen saturation of 94% or greater. Aspirin (up to 325 mg) should also be administered as soon as possible, unless the patient is allergic to it. After applying oxygen and administering aspirin, you should perform a physical exam and obtain baseline vital signs. You would inquire about any prescription medications the patient is taking (eg, NTG) during the SAMPLE history.
question
A 29-year-old woman, who is 38 weeks pregnant, presents with heavy vaginal bleeding, a blood pressure of 70/50 mm Hg, and a heart rate of 130 beats/min. She is pale and diaphoretic, and denies abdominal cramping or pain. Her signs and symptoms are MOST consistent with a/an: A: ruptured ovarian cyst. B: placenta previa. C: abruptio placenta. D: ruptured ectopic pregnancy.
answer
B: placenta previa. Reason: Of the conditions listed, placenta previa would be the least likely to present with abdominal pain, although some patients may have pain or cramping. Placenta previa is a condition in which the placenta develops over and covers some or all of the cervix. As the cervix dilates, the vasculature that attaches the placenta to the uterine wall tears, resulting in vaginal bleeding that is often severe enough to cause shock. By contrast, abruptio placenta is a condition in which the placenta prematurely separates from the uterine wall; it is characterized by tearing abdominal pain, heavy vaginal bleeding, and shock. Placenta previa and abruptio placenta occur during the later stages of pregnancy. A ruptured ovarian cyst typically causes lower abdominal pain, often unilateral. Ectopic pregnancy, a condition in which the egg implants and grows outside the uterus (usually in a fallopian tube), is a first trimester condition; it is typically discovered between 8 and 10 weeks of pregnancy. If the ectopic pregnancy ruptures, the patient often presents with a sudden stabbing pain in the lower abdomen and shock due to intraabdominal hemorrhage.
question
When performing two-rescuer CPR on an adult patient whose airway has not been secured with an advanced device, you should: A: avoid synchronizing compressions with ventilations B: deliver ventilations at a rate of 8 to 10 breaths/min. C: continue ventilations as the AED analyzes the patient's cardiac rhythm. D: have your partner pause after 30 compressions as you give 2 breaths.
answer
D: have your partner pause after 30 compressions as you give 2 breaths. Reason: When performing two-rescuer adult CPR, you should perform cycles of CPR, with a compression to ventilation ratio of 30:2. If the airway is not secured with an advanced device (eg, ET tube, multilumen airway, supraglottic airway) ventilations and chest compressions should be coordinated (synchronous). After your partner delivers 30 compressions, he or she should pause as you deliver two breaths. After the airway has been secured with an advanced device, do not attempt to synchronize compressions and ventilations. Compressions should be performed continuously at a rate of at least 100/min and ventilations should be given at a rate of 8 to 10 breaths/min (one breath every 6 to 8 seconds). All contact with the patient must cease as the AED is analyzing the cardiac rhythm.
question
A 22-year-old man was stabbed in the chest with a large knife. The patient is pulseless and apneic, and the knife is impaled in the center of his chest. Treatment should include: A: stabilizing the knife, applying an occlusive dressing, and providing rapid transport. B: stabilizing the knife, starting CPR, and providing rapid transport. C: removing the knife, applying an occlusive dressing, and providing rapid transport. D: removing the knife, starting CPR, and providing rapid transport.
answer
D: removing the knife, starting CPR, and providing rapid transport. There are two indications for removing an impaled object: when the object is causing airway compromise and when the object interferes with your ability to perform CPR. A knife impaled in the center of the chest, which is where chest compressions are performed, in a patient who is in cardiac arrest must be carefully removed. Quickly cover the wound to control any bleeding (an occlusive dressing covered by a sterile dressing is preferred) and begin CPR immediately.
question
Which of the following statements regarding the automated external defibrillator (AED) is correct? A: AEDs can safely be used in infants and children less than 8 years of age B: AEDs will analyze the patient's rhythm while CPR is in progress C: The AED should be applied to patients at risk for cardiac arrest D: The AED should not be used in patients with an implanted defibrillator
answer
A: AEDs can safely be used in infants and children less than 8 years of age Reason: According to the 2010 guidelines for CPR and Emergency Cardiac Care (ECC), the AED can safely be used in infants and children less than 8 years of age. Although a manual defibrillator is preferred in infants, an AED can be used. When using the AED in infants and children, you should use pediatric pads and a dose-attenuating system (energy reducer); however, if these features are not available, adult AED pads should be used. The AED should only be applied to patients in cardiac arrest; if a patient is at risk for cardiac arrest, have the AED ready but not applied. The AED will not analyze the cardiac rhythm if the patient is moving (ie, CPR is in progress). AEDs can be used in patients with an automated implanted cardioverter/defibrillator (AICD) or implanted pacemaker; ensure that the pads are at least 1" away from the implanted device.
question
You are called to an assisted living center where an attendant found a 72-year-old man unresponsive. The patient had recent hip surgery and has been taking Vicodin for pain. His respirations are slow and shallow and his pulse is slow and weak. You should: A: request an ALS ambulance to respond to the scene. B: apply the AED in case he develops cardiac arrest. C: begin ventilation assistance with a bag-mask device. D: apply high-flow oxygen via a nonrebreathing mask.
answer
C: begin ventilation assistance with a bag-mask device. Reason: Vicodin is a combination of hydrocodone and acetaminophen (APAP), the active ingredient in Tylenol. Hydrocodone is a potent narcotic analgesic. When taken in excess, it can suppress the central nervous system and cause respiratory depression, bradycardia, and hypotension. Initial management of any patient who has overdosed on a medication of this type is to ensure a patent airway and support breathing. Because the patient is breathing inadequately (slow and shallow), immediate ventilation assistance is needed. Consider requesting an ALS ambulance if transport time to the nearest hospital will be lengthy. Paramedics can administer a drug called naloxone (Narcan) to reverse the effects of narcotic drugs. The AED is not indicated for this patient; it is only applied to patients in cardiac arrest.
question
Which of the following assessment parameters is a more reliable indicator of perfusion in infants than adults? A: Capillary refill B: Pulse quality C: Level of orientation D: Blood pressure
answer
A: Capillary refill Reason: Capillary refill time (CRT) is a reliable indicator of perfusion in children less than 6 years of age. When the capillary bed (eg, fingernail, forehead) is blanched, blood should return to the area in less than 2 seconds. Because peripheral perfusion decreases with age, CRT is a less reliable indicator of perfusion in older children and adults. Note that cold temperatures can affect CRT. Pulse quality is reliable in patients of any age; weak or absent peripheral pulses indicate poor perfusion in anyone. Blood pressure is the least reliable indicator of perfusion in patients of any age; it usually does not fall until the body's compensatory mechanisms have failed. Assessing an infant's level of orientation is not possible; infants do not know who they are, where they are, what happened, and what day it is. When assessing an infant's mental status, note his or her level of alertness and interactivity (eg, tracking with his or her eyes, crying versus quiet).
question
Following blunt injury to the anterior torso, a patient is coughing up bright red blood. You should be MOST suspicious of: A: intraabdominal bleeding. B: bleeding within the lungs. C: gastrointestinal bleeding. D: severe myocardial damage.
answer
B: bleeding within the lungs. Reason: Hemoptysis (coughing up blood) is a finding that suggests injury to or bleeding within the lungs. Vomiting of bright or dark red blood (hematemesis) suggests gastrointestinal bleeding. Intraabdominal bleeding presents with signs of shock as well as a rigid, bruised, or distended abdomen. Damage to the myocardium typically does not cause hemotysis unless it is associated with lung injury.
question
A properly placed oropharyngeal airway: A: keeps the tongue off of the posterior pharynx. B: will not stimulate a conscious patient's gag reflex. C: prevents aspiration if the patient regurgitates. D: eliminates the need to perform a head tilt-chin lift.
answer
A: keeps the tongue off of the posterior pharynx. Reason: The oropharyngeal (oral) airway is an artificial adjunct used to keep the tongue away from the posterior pharynx (back of the throat), thus preventing it from blocking the upper airway. It is used in conjunction with, not in lieu of, the head tilt-chin lift or jaw-thrust maneuver to maintain patency of the airway. The oral airway will not prevent aspiration if the patient regurgitates because it does not occlude the esophagus or protect the trachea. The oral airway is contraindicated in conscious patients and in all patients, even those who are unconscious, who have an intact gag reflex. Stimulation of the gag reflex may cause vomiting and aspiration.
question
When ventilating an apneic patient, you note decreased ventilatory compliance. This means that: A: the lungs are difficult to ventilate. B: fluid is occupying the alveoli. C: the upper airway is blocked. D: you meet no resistance when ventilating.
answer
A: the lungs are difficult to ventilate. Reason: As it applies to artificial ventilation, compliance is the ability of the lungs to expand during ventilation. Increased ventilatory compliance means that no resistance is met when you ventilate the patient; you can ventilate the lungs with ease. Decreased ventilatory compliance means that significant resistance is met when you ventilate the patient; the lungs are difficult to ventilate. Conditions such as upper airway obstruction, widespread bronchospasm, fluid in the alveoli (eg, pulmonary edema), and COPD can all cause decreased ventilatory compliance.
question
When assessing a 30-year-old female who was sexually assaulted, it is MOST important for you to: A: ensure that all life-threatening injuries are treated. B: discourage her from showering or changing clothes. C: have a female EMT perform the assessment. D: recognize that the patient is a walking crime scene.
answer
A: ensure that all life-threatening injuries are treated. Reason: Victims of sexual assault can present a unique challenge for the EMT. The patient is a walking crime scene; potential evidence could be on or in him or her. Furthermore, many victims will not want to be assessed by a member of the opposite sex. Like any other patient, however, your first priority is to assess for and treat life-threatening injuries or conditions and begin immediate transport if indicated. If possible, an EMT of the opposite sex should assess the patient. To help preserve potential evidence, discourage the patient from showering, douching, going to the bathroom, or changing clothes.
question
A young male has an open abdominal wound through which a small loop of bowel is protruding. There is minimal bleeding. The BEST way to treat his injury is to: A: gently clean the exposed loop of bowel with warm sterile saline, carefully replace it back into the wound, and cover it with a dry sterile dressing. B: apply dry sterile gauze pads to the wound and then keep them continuously moist by pouring sterile saline or water on them throughout transport. C: apply a sterile trauma dressing moistened with sterile saline directly to the wound and secure the moist dressing in place with a dry sterile dressing. D: cover the wound with a dry sterile trauma dressing and tightly secure it in place by circumferentially wrapping roller gauze around the abdomen.
answer
C: apply a sterile trauma dressing moistened with sterile saline directly to the wound and secure the moist dressing in place with a dry sterile dressing. Reason: An abdominal evisceration occurs when a loop of bowel, an organ, or fat protrudes through an open abdominal injury. Never try to replace an organ that is protruding from an open abdominal wound, whether it is a small fold of peritoneum or nearly all of the intestines; this significantly increases the risk of infection. Instead, cover it with sterile gauze pads or a sterile trauma dressing moistened with sterile saline and secure the moist dressing in place with a dry sterile dressing. Some EMS protocols call for an occlusive dressing over the organs, secured by trauma dressings. Do not apply excessive pressure when dressing and bandaging the wound; this may force the protruding organ or loop of bowel back into the abdominal cavity.
question
A 60-year-old male complains of a tearing sensation in his abdomen. He tells you the pain began suddenly and feels like someone is sticking a knife into his abdomen. He is conscious and alert with a blood pressure of 148/88 mm Hg, a pulse of 120 beats/min, and respirations of 22 breaths/min. In addition to administering high-flow oxygen, you should: A: transport at once and be prepared to treat him for severe shock. B: auscultate over his epigastrium to assess for bowel sounds. C: perform a rapid head to toe assessment and prepare for transport. D: vigorously palpate his abdomen to assess for a pulsating mass.
answer
A: transport at once and be prepared to treat him for severe shock. Reason: Given the onset and nature of the patient's pain (eg, sudden onset, tearing sensation), you should suspect that he has an acute dissection of the abdominal aorta. Administer high-flow oxygen and transport him at once. Acute aortic dissection can quickly cause an aneurysm, which could rupture and cause profound shock. Therefore, you must carefully monitor him and be prepared to treat him accordingly. Unnecessary or vigorous palpation of his abdomen could cause his aorta to rupture and should be avoided. A rapid head-to-toe assessment is indicated for trauma patients with a significant mechanism of injury and unresponsive medical patients; this patient falls into neither of these categories. Auscultating bowel sounds in the field is time-consuming, will yield little information, and only delays transport.
question
A 3-year-old child has a sudden onset of respiratory distress. The mother denies any recent illnesses or fever. You should suspect: A: foreign body airway obstruction. B: croup. C: lower respiratory infection. D: epiglottitis.
answer
A: foreign body airway obstruction. Reason: You should suspect a foreign body airway obstruction in any child who presents with an acute onset of respiratory distress in the absence of fever. Croup, epiglottitis, and lower airway infections (ie, bronchiolitis, bronchitis) commonly present with a fever. If the child is experiencing a mild airway obstruction, in which he or she is moving adequate air, has a normal level of consciousness, and pink skin, do not attempt to relieve the airway obstruction; doing so may result in a severe airway obstruction. Offer oxygen and transport the child to the hospital without delay. If signs of a severe airway obstruction are present (ie, ineffective cough, decreased level of consciousness, cyanosis), you should perform abdominal thrusts until the object is expelled or the child becomes unresponsive. If the child becomes unresponsive, perform chest compressions.
question
Priority treatment for a large avulsion includes: A: immobilizing the injured area. B: cleaning the wound. C: assessing distal circulation. D: controlling any bleeding.
answer
D: controlling any bleeding. Reason: Immediate treatment for any soft-tissue injury begins with controlling any external bleeding. Once the bleeding is controlled, distal circulation, motor, and sensory functions should be assessed, the wound dressed and bandaged, and then distal circulation, motor, and sensory functions reassessed. The injured area can be immobilized as well to prevent further injury and to help reduce bleeding. Generally, open wounds are not cleaned in the field unless they are grossly contaminated with large debris.
question
A patient with a spinal injury may still be able to use his or her diaphragm to breathe, but would lose control of the intercostal muscles, if the spinal cord is injured: A: below the C5 level. B: above the C3 level. C: above the C5 level. D: between C1 and C2.
answer
A: below the C5 level. Reason: The nerves that supply the diaphragm (the phrenic nerves) exit the spinal cord at C3, C4, and C5. A patient whose spinal cord is injured below the C5 level will lose the ability to move his or her intercostal muscles (the muscles in between the ribs), but the diaphragm will still contract. The patient may still be able to breathe because the phrenic nerves remain intact. Patients with spinal cord injuries at C3 or above often lose their ability to breathe entirely. Remember this: C3, 4, and 5 keep the diaphragm alive.
question
A patient whose artificial pacemaker has failed would MOST likely experience: A: irreversible ventricular fibrillation. B: hypertension and a headache. C: weakness and bradycardia. D: dizziness and excessive tachycardia
answer
C: weakness and bradycardia. Reason: An artificial pacemaker is implanted in a person whose own cardiac electrical conduction system cannot maintain a regular rhythm and rate. If a pacemaker stops working, as when the battery wears out or an internal lead becomes detached, the patient often experiences syncope, dizziness, or weakness because of an excessively slow heart rate (bradycardia). The pulse rate is typically less than 60 beats/min because the heart is beating without the stimulus of the pacemaker and without regulation of its own electrical conduction system, which may be damaged. In these circumstances, the heart tends to assume a fixed slow rate that may not be fast enough to maintain adequate cardiac output. In some cases, the patient's heart rate may be so low that he or she becomes hypotensive.
question
To obtain the MOST reliable assessment of a patient's tidal volume, you should: A: assess for retractions. B: listen for airway noises. C: count the respiratory rate. D: look at the rise of the chest.
answer
D: look at the rise of the chest. Reason: Tidal volume is the amount of air, in milliliters, breathed into or out of the lungs in a single breath. The most effective (and practical) way to assess tidal volume is to evaluate the rise of the patient's chest. If the patient's chest rises minimally during inhalation, his or her respirations are shallow; shallow respirations reflect a reduced tidal volume.
question
An elderly woman, who was removed from her burning house by firefighters, has full-thickness burns to approximately 50% of her body. Appropriate treatment for this patient should include: A: peeling burned clothing from the skin and removing all rings, necklaces, and bracelets. B: applying moist, sterile dressings to the burned areas and preventing hypothermia. C: cooling the burns with sterile saline and covering them with dry, sterile burn pads. D: covering the burns with dry, sterile dressings and preventing further loss of body heat.
answer
D: covering the burns with dry, sterile dressings and preventing further loss of body heat. Reason: After moving the patient to safety, stopping the burning process, and supporting the ABCs, full-thickness burns should be cared for by applying dry, sterile dressings or burn pads and preventing hypothermia. Cooling full-thickness burns (ie, applying moist dressings, pouring saline or water on the burn) should be avoided as this increases the risks of hypothermia and infection. Rings, necklaces, and other potentially constrictive devices should be removed in the event that severe swelling occurs. If portions of clothing are adhered to the skin, they should be cut around, not peeled from the skin, in order to prevent further soft-tissue damage.
question
A middle-aged male was found unresponsive by his wife. When you arrive at the scene, you assess the patient and determine that he is apneic and pulseless. You should: A: begin CPR starting with chest compressions, apply the AED as soon as possible, and request backup. B: immediately begin CPR, reassess for a carotid pulse after 60 seconds, and then apply the AED. C: immediately apply the AED, analyze his cardiac rhythm, deliver a shock if indicated, and begin CPR. D: perform CPR with a compression-to-ventilation ratio of 15:2, apply the AED, and request backup.
answer
A: begin CPR starting with chest compressions, apply the AED as soon as possible, and request backup. Reason: As soon as you determine that a patient is unresponsive, pulseless, and apneic, you should begin CPR starting with chest compressions. The appropriate compression-to-ventilation ratio for adult CPR (one- or two-rescuer) is 30:2. A compression-to-ventilation ratio of 15:2 is used for two-rescuer infant and child CPR. Request a backup ambulance as soon as possible; however, do not interrupt CPR to do so. One EMT should perform CPR while the other radios for assistance. Continue CPR and reanalyze the patient's cardiac rhythm every 2 minutes. If indicated, deliver a single shock and immediately resume CPR, starting with chest compressions. If the AED gives a no shock message, resume CPR, starting with chest compressions. Continue CPR, rhythm analysis every 2 minutes, and defibrillation (if indicated), until backup arrives or the patient starts to move.
question
Which of the following patients has signs of inadequate breathing? A: A 50-year-old woman with respirations of 12 breaths/min and pink, dry skin B: A 60-year-old man with clear and equal breath sounds bilaterally C: A 41-year-old woman with shallow respirations of 14 breaths/min D: A 30-year-old man with respirations of 12 breaths/min with adequate depth
answer
C: A 41-year-old woman with shallow respirations of 14 breaths/min Reason: Although the 41-year-old woman has a respiratory rate that falls within the normal range for an adult, the depth of her breathing is shallow (reduced tidal volume). Signs of inadequate breathing in the adult include a slow (less than 12 breaths/min) or fast (greater than 20 breaths/min) respiratory rate, shallow depth (reduced tidal volume), altered level of consciousness, tachycardia, an irregular pattern of inhalation and exhalation, diminished breath sounds during auscultation, and cyanosis. It is important to assess ALL components of a patient's breathing: rate, regularity, depth, and quality. Do not rely solely on one parameter.
question
Ventilation is defined as the: A: movement of air into and out of the lungs. B: volume of air inhaled into the lungs in a single breath. C: exchange of oxygen and carbon dioxide at the cell level. D: elimination of carbon dioxide from the body.
answer
A: movement of air into and out of the lungs. Reason: Ventilation is defined as the movement of air into and out of the lungs. During negative-pressure ventilation (normal breathing), the diaphragm and intercostal muscles contract, which increases the vertical and horizontal dimensions of the chest cavity. As a result, a vacuum is created in the chest and air is drawn into the lungs. Positive-pressure ventilation is the act of forcing air into the lungs (ie, bag-mask ventilation). The volume of air inhaled or exhaled in a single breath is called tidal volume. The exchange of gases between the body and its environment is called respiration; therefore, the exchange of oxygen and carbon dioxide at the cell level is called cellular (internal) respiration. During pulmonary (external) respiration, oxygen and carbon dioxide are exchanged in the lungs; oxygenated blood returns to the left side of the heart and carbon dioxide is eliminated from the body during exhalation.
question
Which position is MOST appropriate for a mother in labor with a prolapsed umbilical cord? A: Left side with legs elevated B: Supine with hips elevated C: Supine with legs elevated D: Left lateral recumbent
answer
B: Supine with hips elevated Reason: When the umbilical cord is prolapsed, the infant typically slides down the birth canal and rests on top of the cord, shutting off its own oxygen supply. Placing the mother supine with her hips elevated will cause the baby to slide back into the birth canal slightly, thereby relieving pressure off of the cord. It may be necessary to insert your gloved fingers into the mother's vagina and lift the baby's head off of the cord. Give the mother high-flow oxygen and transport without delay. A lateral recumbent (on the side) position is appropriate for pregnant women without a prolapsed cord and will help prevent the occurrence of supine hypotensive syndrome, a condition in which the pregnant uterus compresses the inferior vena cava and compromises cardiac output.
question
You assess an unresponsive 65-year-old man and find that he is apneic and pulseless. The patient's wife tells you that he has an automatic implanted cardioverter/defibrillator. After initiating CPR, you should: A: avoid using the AED because the implanted defibrillator is more effective. B: deactivate the implanted defibrillator by running a magnet over it. C: ask the wife why and when he had the automatic defibrillator implanted. D: apply the AED as soon as possible and analyze his cardiac rhythm.
answer
D: apply the AED as soon as possible and analyze his cardiac rhythm. Reason: Some patients who are at high risk for sudden cardiac arrest due to ventricular fibrillation (V-Fib) have a small automatic implanted cardioverter/defibrillator (AICD). The AICD attaches directly to the heart and continuously monitors the cardiac rhythm, delivering a shock if V-Fib or another lethal dysrhythmia is detected. Regardless of whether the patient has an AICD, he or she should be treated like all other cardiac arrest patients. Perform CPR and use the AED as usual; however, you should ensure that the AED pads are at least 1" away from the implanted device. Generally, the electricity from the AICD is so low that it will have no effect on rescuers and therefore should not be of concern to you. Do not deactivate an implanted AICD, especially if it is working and delivering shocks as it is supposed to. When treating a cardiac arrest patient who has an AICD, your priority is to provide CPR and defibrillate with the AED if indicated, not to determine when and why the AICD was implanted.
question
A man armed with a shotgun has taken two people hostage and has shot one of them. Upon arriving at the scene, you should: A: have the incident commander guide you to a shielded staging area and wait for the tactical team to bring the patient to you. B: leave your lights and siren on because this will let the injured person know that you have arrived and are there to help. C: be sure and turn up your portable radio loud enough so that you can remain aware of the entire situation. D: inform the incident commander that you will assume responsibility for the entire incident since there is a confirmed patient.
answer
A: have the incident commander guide you to a shielded staging area and wait for the tactical team to bring the patient to you. Reason: Upon arriving at the scene of a tactical situation, such as a hostage situation, the presence of a sniper, or any exchange of gunfire, you should report to the incident commander, who will take you to a shielded, safe staging area that has been selected for the ambulance and for treatment of casualties. Remain there until the tactical team brings the patient or patients to you. As an EMT, you are responsible for patient care once the patient has been brought to you; you are not in charge of the entire incident. When you arrive at the scene, turn your lights and siren off to avoid agitating the gunman. You should also keep your portable radio turned down and minimize radio traffic. If possible, use an ear speaker.
question
Which of the following occurs during positive-pressure ventilation? A: Intrathoracic pressure increases B: Oxygen is pulled into the lungs C: The esophagus remains closed D: Blood is drawn back to the heart
answer
A: Intrathoracic pressure increases Reason: Negative-pressure ventilation, the act of normal breathing, occurs when the diaphragm and intercostal muscles contract. The actions of these muscles create a vacuum (negative pressure), which pulls oxygen-rich air into the lungs. Because of the negative pressure created in the chest, blood is naturally drawn back to the heart. The esophagus remains closed during normal breathing. In contrast, positive-pressure ventilation involves the forcing of air into the lungs, such as what is provided during rescue breathing. Positive-pressure ventilation causes an increase in intrathoracic pressure, which can impair blood flow back to the heart and cause a decrease in cardiac output. During positive-pressure ventilation, the esophagus is forced open and air enters the stomach (gastric distention); this could result in vomiting and aspiration.
question
A 30-year-old man sustained partial-thickness burns to the anterior chest and both anterior arms. Based on the Rule of Nines, what percentage of his body surface area has been burned? A: 9% B: 36% C: 18% D: 27%
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C: 18% Reason: According to the adult Rule of Nines, the anterior trunk (chest and abdomen) accounts for 18% of the total body surface area (TBSA) and each entire arm accounts for 9%. Therefore, the anterior chest, which is one half of the trunk, would account for 9% of the TBSA, and both anterior arms (4.5% each) would account for 9% TBSA, for a total of 18% TBSA burned.
question
During the triage process, which of the following injuries or conditions would classify a patient as a high priority? A: Unilateral femur fracture and tachycardia B: A large avulsion to the arm and an altered mental status C: Partial-thickness burns with no respiratory difficulty D: Pulselessness and apnea
answer
B: A large avulsion to the arm and an altered mental status Reason: During triage, patients with an altered mental status, who are in shock, or who have problems with airway, breathing, or circulation, are potentially salvageable and are given immediate priority. Patients who are pulseless and apneic have low priority in a mass-casualty situation. If you focus your efforts on cardiac arrest patients, who will most likely not survive anyway, patients who could have potentially been saved will die as well. Remember, the goal of triage is to provide the greatest good for the greatest number of patients.
question
You are assessing a 26-year-old woman who is 38 weeks pregnant and is in labor. She tells you that she was pregnant once before, but had a miscarriage at 19 weeks. You should document her obstetric history as: A: gravida 0, para 2. B: gravida 2, para 1. C: gravida 1, para 1. D: gravida 2, para 0.
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D: gravida 2, para 0. Reason: Gravida is the term used to describe the number of times a woman has been pregnant, regardless of whether or not she carried the infant to term. Para is the term used to describe the number of times a woman has carried a fetus beyond 28 weeks, regardless of whether or not the infant was born dead or alive. Because your patient is currently pregnant and was pregnant once before, she is gravida 2. However, because she had a miscarriage with her first pregnancy (she did not carry beyond 28 weeks), and has not yet delivered the baby she is currently carrying, she is para 0. When she delivers, she will become gravida 2 and para 1.
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In which of the following situations would you MOST likely encounter agonal gasps? A: Significant hypoxemia, regardless of the cause B: Shortly after becoming unresponsive and pulseless C: Occlusion of the posterior pharynx by the tongue D: Any patient who is unresponsive due to hypoxia
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B: Shortly after becoming unresponsive and pulseless Reason: Agonal gasps are occasional, irregular, and ineffective breaths. They are commonly observed in patients shortly after they become unresponsive and pulseless (cardiac arrest). Agonal gasps may also be observed in patients with a severe brain injury or cerebral anoxia (complete absence of oxygen). Patients with agonal gasps require some form of positive-pressure ventilation. Hypoxemic and hypoxic patients typically present with tachypnea (increased respirations) in an attempt to eliminate carbon dioxide and bring in more oxygen. However, as the hypoxic patient begins to decompensate, his or her respirations often become slow (bradypnea). If the tongue is occluding the posterior pharynx, a characteristic snoring sound is typically heard.
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A 60-year-old man presents with chest pain and difficulty breathing. He is pale, diaphoretic, and in severe pain. As your partner applies supplemental oxygen, you assess his vital signs. His blood pressure is 180/90 mm Hg, pulse is 110 beats/min and irregular, and respirations are 24 breaths/min and labored. You ask him if has taken any nitroglycerin and he tells you that he does not have any but his wife does. You should: A: complete your focused physical examination and prepare the patient for immediate transport to an appropriate hospital. B: have him swallow up to four enteric-coated aspirin, continue oxygen therapy, and promptly transport him to the hospital. C: transport at once, apply the AED in case he develops cardiac arrest, and monitor his vital signs en route to the hospital. D: contact medical control and request permission to assist the patient with up to three doses of his wife's nitroglycerin. You selected B; The correct answer is A;
answer
B: have him swallow up to four enteric-coated aspirin, continue oxygen therapy, and promptly transport him to the hospital. Reason: If a patient with suspected cardiac compromise does not have prescribed nitroglycerin (NTG), complete your focused physical examination, continue oxygen therapy, and transport immediately. Do not administer, or request to administer, any medication that is not prescribed to the patient. If the patient develops cardiac arrest, apply the AED and follow its voice prompts. Do not apply the AED to any patient who is not in cardiac arrest. If your protocols allow you to administer aspirin, give up to 325 mg of chewable baby aspirin (have the patient chew the aspirin before swallowing it). Enteric-coated aspirin (aspirin that is coated to prevent stomach upset) is intended to be swallowed without chewing. It takes too long to dissolve, whereas chewable aspirin has a much faster effect.
question
Upon delivery of the baby's head, you note that the umbilical cord is wrapped around its neck. You should: A: make one attempt to gently remove the cord from around its neck. B: keep the cord warm and moist and transport without delay. C: give the mother high-flow oxygen and transport her on her side. D: immediately clamp and cut the cord and continue the delivery.
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A: make one attempt to gently remove the cord from around its neck. Reason: If the umbilical cord is wrapped around the baby's neck (nuchal cord), the EMT should make one attempt to gently remove the cord from around its neck. If this is unsuccessful, clamp and cut the cord and continue with the delivery. A nuchal cord can cause fetal asphyxia and must be treated immediately upon discovery.
question
While ventilating an apneic patient with a bag-mask device, you note minimal rise of the chest each time you squeeze the bag. You should: A: evaluate the mask-to-face seal and the position of the patient's head. B: squeeze the bag harder to ensure delivery of adequate tidal volume. C: ensure that the reservoir is properly attached to the bag-mask device. D: suction the patient's mouth for 15 seconds and reattempt ventilations.
answer
A: evaluate the mask-to-face seal and the position of the patient's head. Reason: If the patient's chest rises minimally or not at all when you are ventilating him or her with the bag-mask device, you should first reevaluate the mask-to-face seal and make sure that the patient's head is properly positioned. The most common complication associated with bag-mask ventilation is difficulty in maintaining an adequate mask-to-face seal. If repositioning the head does not correct the problem, you should ensure that you are squeezing the bag hard enough to deliver adequate tidal volume. Caution must be used, however, when ventilating a patient; breaths that are delivered too forcefully or too fast (hyperventilation) may cause an increase in intrathoracic pressure, thus impeding blood return to the heart and decreasing cardiac output. Forceful ventilations may also cause significant gastric distention. Therefore, you should deliver each breath over a period of one second—just enough to produce visible chest rise. The patient's mouth should be suctioned only if it contains blood or other secretions.
question
The MOST effective means of preventing the spread of disease is: A: wearing a mask with all patients. B: up-to-date immunizations. C: effective handwashing. D: wearing gloves with all patients.
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C: effective hand washing. Reason: According to the Centers for Disease Control and Prevention (CDC), the most effective way of preventing the spread of disease is to frequently and effectively wash your hands, especially in between patients. The regular use of gloves with all patients and wearing a mask when managing a patient with a communicable disease (ie, tuberculosis) will decrease your chance of disease exposure. Remaining up-to-date with your immunizations will reduce your risk of contracting certain diseases if you are exposed.
question
You are at the scene where a man panicked while swimming in a small lake. Your initial attempt to rescue him should include: A: rowing a small raft to the victim. B: throwing a rope to the victim. C: swimming to the victim to rescue him. D: reaching for the victim with a long stick.
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D: reaching for the victim with a long stick. Reason: General rules to follow when attempting to rescue a patient from the water include "reach, throw, row, and then go." In this case, you should attempt to reach the victim by having him grab hold of a large stick or similar object. If this is unsuccessful, throw the victim a rope or flotation device (if available). If these are not available, row to the patient in a small raft (if available). Going into the water to retrieve the victim is a last resort. The rescuer must be a strong swimmer because patients who are in danger of drowning are in a state of blind panic and will make every attempt to keep themselves afloat, even if it means forcing the rescuer underwater.
question
Agonal respirations are not adequate because they are: A: the result of an increase in tidal volume. B: associated with a prolonged inhalation phase. C: infrequent, gasping respiratory efforts. D: characterized by a rapid, irregular pattern.
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C: infrequent, gasping respiratory efforts. Reason: A patient may appear to be breathing after his or her heart has stopped. These occasional, gasping breaths are called agonal respirations (also called agonal gasps) and occur when the respiratory centers in the brain continues to send signals to the respiratory muscles. Agonal respirations are not adequate because they are infrequent, gasping respiratory efforts that produce very little, if any, tidal volume. Patients with agonal respirations require artificial ventilation.
question
A 30-year-old man with a history of schizophrenia cut his wrists and is bleeding profusely. He is confused, combative, and has slurred speech. With the assistance of law enforcement personnel, you and your partner physically restrain him in order to provide care and transport. In this situation, a court of law would MOST likely: A: conclude that you should have had a court order to restrain. B: agree that you and your partner are guilty of assault and battery. C: consider your actions in providing care to be appropriate. D: determine that the patient had decision-making capacity.
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C: consider your actions in providing care to be appropriate. Reason: An adult with decision-making capacity (ie, a mentally competent adult) has the legal right to refuse medical treatment, even if that treatment involves lifesaving care. In psychiatric cases, however, a court of law would likely consider your actions in providing lifesaving care to be appropriate, particularly if you have a reasonable belief that the patient would harm him- or herself or others without your intervention. In addition, a patient who is in any way impaired, whether by mental illness, medical condition, or intoxication, may not be considered competent to refuse treatment and transport. If you are unsure of a patient's decision-making capacity, err on the side of treatment and transport. Few would argue that it would be easier to defend why you treated a patient than to justify or defend why you abandoned a patient.
question
Immediately upon delivery of a newborn's head, you should: A: dry the face. B: cover the eyes. C: suction the nose. D: suction the mouth.
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D: suction the mouth. Reason: As soon as the newborn's head has delivered, you should first suction the mouth, then the nose. As the infant is forced through the birth canal, the thoracic cavity is squeezed, which causes the infant to expel amniotic fluid from the lungs. If this fluid is not thoroughly suctioned, it can be aspirated, resulting in inadequate ventilation and hypoxia. Immediately before or after suctioning the infant's airway, you should check for the presence of a nuchal cord (umbilical cord wrapped around the neck).
question
When treating a patient with chest pain, pressure, or discomfort, you should first: A: request an ALS ambulance response to the scene. B: assess the blood pressure and give nitroglycerin. C: place the patient in a position of comfort. D: administer supplemental oxygen.
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C: place the patient in a position of comfort. Reason: An important aspect of treating a patient with chest pain, pressure, or discomfort is to ensure that the patient is in a comfortable position. Most of the time, the patient will already be in this position upon your arrival. A position of comfort will aid in minimizing anxiety, which in turn decreases cardiac oxygen consumption and demand. After ensuring that the patient is in a comfortable position, administer supplemental oxygen in a concentration sufficient to maintain an SpO2 of greater than 94%. Following your assessment, if you feel that ALS support is needed, you should request it. If the patient has prescribed, unexpired nitroglycerin; the systolic blood pressure is greater than 100 mm Hg; and the patient has not taken the maximum of three doses, you should contact medical control to obtain permission to assist the patient in taking the nitroglycerin.
question
The myocardium receives its blood supply from the coronary arteries that branch directly from the: A: right ventricle. B: vena cava. C: aorta. D: left atrium.
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C: aorta. Reason: The aorta, which is the largest artery in the human body, originates immediately from the left ventricle where it branches into the coronary arteries. This allows the myocardium to receive blood that has the highest concentration of oxygen. The superior and inferior venae cavae return oxygen-poor blood from the systemic circulation back to the right atrium, where it is pumped into the right ventricle. The left atrium receives freshly oxygenated blood from the lungs.
question
Prevention of cardiac arrest in infants and small children should focus primarily on: A: providing immediate transport. B: keeping the child warm. C: avoiding upsetting the child. D: ensuring adequate ventilation.
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D: ensuring adequate ventilation. Reason: The most common cause of cardiac arrest in infants and children is failure of the respiratory system. Their hearts generally are healthy, and they rarely go into ventricular fibrillation (V-Fib). The key to preventing cardiac arrest in the majority of infants and children is to ensure adequate ventilation and oxygenation.
question
A conscious and alert 92-year-old woman with chest pain is refusing EMS treatment and transport to the hospital. Her family insists that you transport her. This situation is MOST appropriately managed by: A: advising the patient of the risks of refusing care. B: transporting the patient as the family wishes. C: transporting the patient as you explain your actions. D: obtaining a signed refusal from a family member.
answer
A: advising the patient of the risks of refusing care. Reason: Just because the patient is 92 years old does not mean that she does not have decision-making capacity and cannot make an informed decision. In cases where any patient refuses care, after determining that the patient has decision-making capacity (ie, is of legal age, is not impaired by drugs or alcohol), you must inform the patient of the potential risks of refusing care, namely death. If the patient is aware of and willing to accept the potential consequences of his or her refusal, a refusal of treatment and/or transport form should be signed by the patient. A non-biased witness (ie, law enforcement officer, emergency medical responder [EMR]) should also sign the refusal form.
question
Which of the following actions should be carried out during the primary assessment of an unresponsive patient? A: Assessing the skin B: Auscultating the lungs C: Palpating the cranium D: Obtaining a blood pressure
answer
A: Assessing the skin Reason: Components of the primary assessment for both responsive and unresponsive patients include assessing and managing the airway and assessing and managing circulation, which includes controlling any major bleeding; assessing the rate, regularity, and quality of the pulse; and assessing the color, condition, and temperature of the skin.
question
Sonorous respirations are MOST rapidly corrected by: A: inserting an oropharyngeal airway. B: correctly positioning the head. C: suctioning the oropharynx. D: initiating assisted ventilations.
answer
B: correctly positioning the head. Reason: Sonorous (snoring) respirations, which most commonly result from partial airway obstruction by the tongue, are most rapidly corrected by simply positioning the head. This involves using either the head tilt-chin lift or the jaw-thrust maneuver if trauma is suspected. To further ensure airway patency, a simple adjunct (oral or nasal airway) may need to be inserted. The patient's airway should be suctioned if a gurgling sound is heard during breathing.
question
You are treating a 5-year-old child who has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. Supplemental oxygen has been given and you have elevated his lower extremities. En route to the hospital, you note that his work of breathing has increased. You should: A: begin positive-pressure ventilations and reassess the child. B: lower the extremities and reassess the child. C: listen to the lungs with a stethoscope for abnormal breath sounds. D: insert a nasopharyngeal airway and increase the oxygen flow.
answer
B: lower the extremities and reassess the child. Reason: Because infants and small children rely heavily on their diaphragm for breathing (as evidenced by belly breathing), elevating their lower extremities can cause the diaphragm to shift into the thoracic cavity and decrease the effectiveness of breathing. Therefore, in the case of this child, you should lower the lower extremities and reassess. In fact, you should only elevate a shock patient's lower extremities if allowed by local protocol.
question
Which of the following components is NOT part of an injury or illness prevention program? A: Training a group of daycare employees on infant and child CPR B: Inspecting the home of young parents for child safety locks C: Teaching new parents how to properly install a child safety seat D: Educating teenage students on the dangers of drinking and driving
answer
A: Training a group of daycare employees on infant and child CPR Reason: The operative word in injury and illness prevention is "prevention." An injury or illness prevention program should focus on actions that prevent illness or injury. These include, but are not limited to, teaching new parents how to properly install a child safety seat, educating teenage students on the dangers of drinking and driving, and conducting a courtesy inspection of the home of young parents for the presence of child safety locks. Training laypeople on CPR, although a valuable service, is not part of a prevention program; CPR is not needed until an injury or illness has already occurred.
question
You are caring for a 6-year-old child with a possible fractured arm and have reason to believe that the child was abused. How should you manage this situation? A: Call the police and have the parents arrested. B: Advise the parents that the child needs to be transported. C: Transport the child to the hospital regardless of the parents' wishes. D: Inform the parents of your suspicions.
answer
B: Advise the parents that the child needs to be transported. Reason: The responding EMT must handle cases of suspected child abuse with great care. You must never accuse the parents or caregiver of abuse. If you are wrong, you could be held liable for slander. Actions that would suggest such accusation includes summoning the police to have the parents arrested. Instead, you should advise the parents or caregiver that the child needs to be transported by ambulance, even if the injury is not life-threatening. The goal is to get the child to safety; however, this must be done legally (with parental consent). In most cases, you only need the consent of one parent to transport the child. Once at the hospital, you must apprise the physician of your suspicions.
question
You are called to a local nightclub for an injured patient. Law enforcement personnel have secured the scene. Upon arrival, you see a young man who is lying on the ground screaming in pain; bright red blood is spurting from an apparent stab wound to his groin area. You should: A: prevent hypothermia. B: apply 100% oxygen. C: ensure an open airway. D: control the bleeding.
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D: control the bleeding. Reason: This patient's airway is obviously patent; he is screaming in pain. Blood spurting from the groin area indicates arterial bleeding from the femoral artery. If this bleeding is not controlled immediately, the patient will die. Oxygen and other shock treatment (ie, keeping him warm) should be initiated after this life-threatening bleeding is controlled. If you take the time to set up and administer oxygen prior to managing the bleeding, the patient will die. Base your treatment priorities on what will kill the patient first.
question
Which of the following is the BEST indicator of cardiac output? A: Pulse rate and quality B: Systolic blood pressure C: Condition and color of the skin D: Quality of the respirations
answer
A: Pulse rate and quality Reason: Cardiac output is the amount of blood ejected from the ventricles each minute. To best obtain an indication of cardiac output, you should assess the rate and quality of the pulse. A rapid, bounding pulse indicates increased cardiac output, whereas a weak or "thready" pulse indicates a decreased cardiac output. Changes in pulse quality (strength) will likely be detected before a drop in systolic blood pressure.
question
A 60-year-old woman presents with acute respiratory distress. She is conscious and alert, but restless. Her respiratory rate is 26 breaths/min with adequate chest expansion, her breath sounds are clear to auscultation bilaterally, and her oxygen saturation is 90%. Which of the following is the MOST appropriate treatment for this patient? A: A nasopharyngeal airway and assisted ventilations B: A nasopharyngeal airway and supplemental oxygen C: A nasal cannula with the flowmeter set at 4 to 6 L/min D: Supplemental oxygen with a nonrebreathing mask
answer
D: Supplemental oxygen with a nonrebreathing mask Reason: Although the patient is restless—a sign of hypoxemia—she is conscious and alert and able to maintain her own airway; therefore, an airway adjunct is not needed at this point. Furthermore, her respirations, although increased in rate, are producing adequate tidal volume as evidenced by adequate chest expansion. Therefore, she is not in need of assisted ventilation at this point. Considering her oxygen saturation of 90%, the most appropriate treatment would be to administer high-flow oxygen with a nonrebreathing mask and closely monitor her for signs of inadequate breathing (ie, shallow breaths [reduced tidal volume], decreased level of consciousness, cyanosis). An acutely hypoxemic patient requires more oxygen than a nasal cannula can provide.
question
A 4-year-old boy with a tracheostomy tube is experiencing respiratory distress. He has intercostal retractions, a heart rate of 80 beats/min, and an oxygen saturation of 85%. During his attempts to breathe, a gurgling sound is heard in the tracheostomy tube. You should: A: place an oxygen mask over the tracheostomy tube. B: carefully suction the tracheostomy tube. C: ventilate through the tracheostomy tube. D: remove the tracheostomy tube and clean it.
answer
B: carefully suction the tracheostomy tube. Reason: Obstruction of a tracheostomy tube with thick secretions is a common complication. You must first suction the tube to ensure that it is clear of secretions; this will usually improve the patient's condition. Do not vigorously suction the tube, however, as this may cause a further decrease in the child's heart rate. Placing an oxygen mask over an obstructed tracheostomy tube will be of little to no benefit. If the child's condition does not improve following suctioning (eg, he remains bradycardic, his oxygen saturation remains low), attach a bag-mask device to the tracheostomy tube and begin ventilating him. Do not remove the tracheostomy tube; this is beyond the EMT's scope of practice, plus there is no guarantee that you will be able to replace it.
question
If an adult patient presents with a respiratory rate of 26 breaths/min, your initial action should be to: A: apply the pulse oximeter and assess his oxygen saturation. B: apply oxygen via a nonrebreathing mask and take his vital signs. C: begin assisting his ventilations with a bag-mask device. D: evaluate his mental status and the depth of his respirations.
answer
D: evaluate his mental status and the depth of his respirations. Reason: The normal respiratory rate for an adult at rest is 12 to 20 breaths/min. If a patient presents with a respiratory rate outside of the normal range, you should immediately assess him or her for other signs of inadequate breathing, such as a decreased level of consciousness, shallow breathing (reduced tidal volume), brief inhalations followed by prolonged exhalations, and cyanosis. If the patient is conscious, alert, and has adequate tidal volume (eg, his or her chest rises adequately with each breath), supplemental oxygen via nonrebreathing mask or nasal cannula would be appropriate, depending on his or her chief complaint and oxygen saturation. However, if the patient's mental status is decreased and his or her tidal volume is reduced (eg, shallow breathing), some form of positive-pressure ventilation should be initiated (eg, bag-mask or pocket face mask ventilations). It is important to note that breathing adequacy is not determined solely by the patient's respiratory rate; you must assess all aspects of breathing (rate, regularity, depth) as well as the patient's mental status. A patient can be breathing at a "normal" rate; however, if his or her tidal volume is reduced, minute volume will decrease and some form of positive-pressure ventilation may be required.
question
While treating a patient in cardiac arrest, you turn the AED on and attach the pads to the patient. However, when the AED begins to analyze the patient's cardiac rhythm, it signals "low battery" and then shuts off. The patient subsequently died. Which of the following statements regarding this scenario is MOST correct? A: Most errors associated with the AED involve equipment failure. B: The crew that preceded you may be held liable for negligence. C: You and your partner may be held liable for negligence. D: The manufacturer of the AED will be held liable for negligence.
answer
C: You and your partner may be held liable for negligence. Reason: The most common errors that occur with the AED are the result of operator error (not equipment failure), usually because no one made sure that the batteries were fully charged when checking the ambulance at the start of the shift. Because the patient died, you and your partner could be held liable for negligence. Remember, the entire ambulance must be checked by the oncoming shift to ensure that all equipment is functional and that all supplies are present. Even though the preceding crew is morally responsible for not replacing the batteries, the legal ramifications will rest on you and your partner's shoulders.
question
How should you classify a patient's nature of illness if he or she has a low blood glucose level, bizarre behavior, and shallow breathing? A: Cardiac compromise B: Altered mental status C: Behavioral emergency D: Respiratory emergency
answer
B: Altered mental status Reason: The nature of illness (NOI) is the medical equivalent to mechanism of injury (MOI). Altered mental status should be the suspected NOI in any patient with any fluctuation in level of consciousness, which can range from bizarre behavior to complete unresponsiveness. Causes of an altered mental status include hypo- or hyperglycemia, head trauma, stroke, behavioral crises, drug overdose, and shock, among others.
question
A woman stabbed her boyfriend in the cheek with a dinner fork during an argument. Police have the woman in custody. The patient still has the fork impaled in his cheek. He is conscious and alert, breathing adequately, and has blood in his oropharynx. You should: A: apply high-flow oxygen via a nonrebreathing mask, carefully remove the fork, and control any external bleeding. B: suction his oropharynx, carefully cut the fork to make it shorter, control any external bleeding, and secure the fork in place. C: carefully remove the fork, suction his oropharynx as needed, and pack the inside of his cheek with sterile gauze pads. D: suction his oropharynx, control any external bleeding, stabilize the fork in place, and protect it with bulky dressings.
answer
D: suction his oropharynx, control any external bleeding, stabilize the fork in place, and protect it with bulky dressings. Reason: An impaled object in the cheek should be removed if it interferes with your ability to manage the patient's airway. In this case, however, the patient is breathing adequately and does not require aggressive airway care (eg, ventilatory assistance). The most practical approach is to suction the blood from his oropharynx, which will prevent him from swallowing it, vomiting it, and aspirating it. Stabilize the fork in place and protect it with bulky dressings; removing an impaled object from the cheek in the opposite direction it entered may cause further soft tissue damage. Transport the patient in a sitting position and suction his oropharynx en route as needed. There is no reason to cut the fork to make it shorter; this will only unnecessarily manipulate it, potentially causing further soft tissue damage and increased bleeding.
question
Clinically, reduced tidal volume would MOST likely present with respirations that are: A: shallow. B: eupneic. C: slow. D: deep.
answer
A: shallow. Reason: Tidal volume is the amount of air, in milliliters, that is breathed into or out of the lungs in a single breath. Shallow respirations (minimal chest rise) indicates that negative-pressure ventilation, and therefore tidal volume, is inadequate. Deep respirations (hyperpnea) would cause an increase in tidal volume. Slow respirations, especially if accompanied by a shallow depth of breathing, would lead to a reduction in minute volume. Eupnea is the medical term for normal breathing; therefore, eupneic respirations are of adequate rate, depth, and regularity.
question
A 33-year-old female presents with acute respiratory distress. She is conscious but anxious, and tells you that she has a history of asthma. She took two puffs of her albuterol inhaler prior to your arrival, but states that it did not help. Her oxygen saturation reads 89% and you hear diffuse wheezing while auscultating her lungs. You should: A: ventilate her with a bag-mask device until her oxygen saturation is at least 94% and rapidly transport her to the closest appropriate medical facility. B: assist her with a third albuterol treatment, contact medical control for further advice, give her high-flow oxygen, and transport her to the hospital. C: give her 100% humidified oxygen to dilate her bronchioles, monitor her oxygen saturation, and transport her to an appropriate medical facility. D: administer high-flow oxygen, contact medical control to request permission to assist her with another albuterol treatment, and prepare for transport.
answer
D: administer high-flow oxygen, contact medical control to request permission to assist her with another albuterol treatment, and prepare for transport. Reason: Despite two albuterol treatments, the patient is still experiencing respiratory distress. Furthermore, the presence of wheezing indicates continued bronchospasm. After administering high-flow oxygen via a nonrebreathing mask, you should contact medical control and request permission to assist the patient with a third albuterol treatment. Drugs such as albuterol (Proventil, Ventolin) and metaproterenol (Alupent) stimulate beta-2 receptors in the lungs, resulting in bronchodilation. Up to three bronchodilator treatments are typically given in the prehospital setting. In most EMS systems, EMTs are not allowed to assist patients with their medication without medical control authorization. After assisting the patient with a third albuterol treatment, reassess her breath sounds and oxygen saturation and transport her promptly.
question
Which of the following is a common side effect of nitroglycerin? A: Nausea B: Hypertension C: Anxiety D: Headache
answer
D: Headache Reason: Because nitroglycerin (NTG) causes vasodilation, including the vessels within the brain, cerebral blood flow increases following the administration of NTG. This often causes a pounding headache for the patient. As uncomfortable as it is for the patient, headaches are a common and expected side effect of the drug. The vasodilatory effects of nitroglycerin could result in hypotension; therefore, the patient's blood pressure should be carefully monitored. Nausea and anxiety are common symptoms of acute coronary syndrome; they are not common side effects of nitroglycerin.
question
Which of the following is the MOST practical method of standard precautions when treating multiple patients during a mass-casualty incident? A: Placing clean gloves over soiled gloves in between patient contacts B: Thoroughly washing your hands in between patient contacts C: Changing your gloves in between contact with different patients D: Asking each patient you treat if he or she has a communicable disease
answer
C: Changing your gloves in between contact with different patients Reason: Although the most effective means of preventing the spread of disease involves thorough hand-washing, this is not practical at the scene of a mass-casualty incident; you usually do not have the time or facilities to do this. In a situation where you are treating multiple patients, you should change your gloves in between patients; this will help prevent cross-contamination. The concept of standard precautions is based on the assumption that ALL bodily fluids are potentially infectious; thus, there is no need to ask a patient if he or she has a communicable disease. Furthermore, to make such an inquiry is unethical.
question
A gang member was cut on the left side of the neck during a fight and is bleeding heavily from the wound. His airway is patent and his breathing is adequate. You should immediately: A: apply a tight pressure dressing and secure it in place with tape. B: cover the wound with an occlusive dressing and apply direct pressure. C: perform a head-to-toe assessment to find and treat other injuries. D: apply high-flow oxygen via a nonrebreathing mask at 15 L/min.
answer
B: cover the wound with an occlusive dressing and apply direct pressure. Reason: Neck lacerations are extremely dangerous and can result in severe bleeding and shock, air embolism, or both. If a jugular vein is lacerated, air can be sucked into the wound, enter the circulatory system, and cause a pulmonary embolism. You should immediately apply an occlusive dressing to the wound (prevents entrainment of air), place a bulky dressing over the occlusive dressing, and apply direct pressure. Your patient has a patent airway and is breathing adequately; although high-flow oxygen is important and should be given as soon as possible, it does not take priority over bleeding control for this particular patient. After treating all airway, breathing, and circulation problems, perform a head-to-toe assessment (if indicated) and prepare for rapid transport.
question
In general, you should avoid rewarming a frostbitten body part in the field if: A: arrival at the emergency department will be delayed. B: the affected part could refreeze after rewarming. C: you are unable to obtain water that is at least 120°F. D: a paramedic is not present to administer analgesia.
answer
B: the affected part could refreeze after rewarming. Reason: Frostbitten body parts should not be rewarmed if there is a chance that they could refreeze after you have rewarmed them. If an extremity thaws and then refreezes, the amount of tissue and cellular damage may be worse than the damage caused by the initial freezing. A delay in getting the patient to the emergency department warrants rewarming. If rewarmed, the extremity should be immersed in water that is 105° to 112°F. Analgesia would certainly be a comfort to the patient, although its absence does not negate rewarming a frostbitten body part in the field.
question
A 45-year-old woman calls EMS because of severe chest pain. When you arrive, she advises you that she has taken two of her husband's nitroglycerin (NTG) tablets without relief. What is your MOST appropriate course of action? A: Apply supplemental oxygen and transport the patient to the hospital without delay. B: Call medical control and request permission to assist the patient with one more NTG tablet. C: Apply oxygen, assess the patient's blood pressure, and give a third and final NTG tablet. D: Attach the AED, administer 100% oxygen, and contact medical control for advice.
answer
A: Apply supplemental oxygen and transport the patient to the hospital without delay. Reason: You should provide supplemental oxygen and prompt transport to any patient who reports chest pain and does not have prescribed nitroglycerin. An EMT who knowingly administers someone else's medication to a patient could be held negligent. Medical control should always be contacted when in doubt. However, bear in mind that medical control will not allow you to assist a patient with someone else's medication. The AED is only applied to patients who are in cardiac arrest; the patient in this scenario is not in cardiac arrest.
question
The ultimate goal of any EMS quality improvement program is to: A: recognize all EMTs who demonstrate consistency in providing competent patient care. B: deliver a consistently high standard of care to all patients who are encountered. C: provide protocols to all EMTs and hold them accountable if protocols are not followed. D: ensure that all personnel receive an adequate number of continuing education hours.
answer
B: deliver a consistently high standard of care to all patients who are encountered. Reason: Providing continuing education to all personnel, recognizing those who consistently provide competent patient care, and holding all personnel accountable for adhering to the EMS protocols are all components of any EMS quality improvement program. The ultimate goal, however, is to provide, as a system, a consistently high standard of care to all patients who are encountered.
question
You arrive at the scene of an 80-year-old woman who is weak and lightheaded. Her son, who called 911, is present and asks you to transport his mother to the hospital. You should: A: take the woman's vital signs and apply supplemental oxygen if necessary. B: advise the son that he can probably drive his mother to the hospital. C: assess the woman and determine if she wishes to be treated and transported. D: comply with the son's request and transport the woman to the hospital.
answer
C: assess the woman and determine if she wishes to be treated and transported. Reason: You must obtain consent from any mentally competent adult patient prior to initiating treatment. Just because the patient is 80 years old does not mean that she does not have decision-making capacity. And just because her son wants her to be transported does not mean that she does. Ask her if she wishes to be treated and transported to the hospital. If she does, then you have obtained consent and should proceed accordingly. If she does not, you should determine if she has decision-making capacity; that is, whether or not she is mentally competent. If she is determined to have decision-making capacity, then you cannot legally treat or transport her. If she does not have decision-making capacity (eg, she is confused, under the influence of drugs or alcohol), then you may treat and transport under the law of implied consent. It is not the EMT's decision to determine, let alone recommend, that a patient be taken to the hospital via privately owned vehicle (POV). If the patient requests EMS treatment and transport, you are legally obligated to do so.
question
In which of the following patients is nitroglycerin contraindicated? A: 41-year-old male with crushing substernal chest pressure, a blood pressure of 160/90 mm Hg, and severe nausea B: 66-year-old female with chest pressure of 6 hours' duration, lightheadedness, and a blood pressure of 110/58 mm Hg C: 53-year-old male with chest discomfort, diaphoresis, a blood pressure of 146/66 mm Hg, and regular use of Levitra D: 58-year-old male with chest pain radiating to the left arm, a blood pressure of 130/64 mm Hg, and prescribed Tegretol
answer
C: 53-year-old male with chest discomfort, diaphoresis, a blood pressure of 146/66 mm Hg, and regular use of Levitra Reason: Nitroglycerin is contraindicated in patients who do not have a prescription for nitroglycerin, in those with a systolic BP less than 100 mm Hg, and in patients who have taken medications for erectile dysfunction (ED) within the previous 24 to 48 hours. Such medications include sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). Because ED drugs and nitroglycerin both cause vasodilation, concomitant use of these drugs may result in significant hypotension. Carbamazepine (Tegretol) is an anticonvulsant medication; there are no known interactions between Tegretol and nitroglycerin.
question
Which of the following conditions would be the LEAST likely to be present in a patient who was submerged in water? A: Gastric distention B: Laryngospasm C: Spinal injury D: Hyperglycemia
answer
D: Hyperglycemia Reason: Many factors can contribute to or result from a submersion injury (eg, drowning, near-drowning). It is not uncommon for a person to experience a spinal injury after diving head first into shallow water, especially if he or she is under the influence of alcohol. When a swimmer panics, he or she initially swallows large amounts of water, resulting in gastric distention. Gastric distention can cause aspiration if the patient regurgitates water during rescue breathing; protect the airway! During the panic phase, the victim expends a tremendous amount of energy (and glucose) from flailing around in the water, possibly resulting in hypoglycemia. Inhaling even a small amount of fresh or salt water can severely irritate the larynx, which sends the muscles of the larynx and vocal cords into spasm (laryngospasm), resulting in airway blockage and hypoxia.
question
As an EMT, your primary responsibility is to: A: keep yourself as safe as possible. B: transport all patients to the hospital. C: provide competent patient care. D: ensure the safety of your partner.
answer
A: keep yourself as safe as possible. Reason: As an EMT, your primary responsibility is to yourself. An injured or dead EMT is of no use to a patient. After ensuring the safety of yourself, your crew, and any bystanders, patient care should be initiated.
question
Which of the following statements regarding the length-based resuscitation tape measure is correct? A: It is not a reliable tool in children who are less than 5 years of age. B: The red end of the tape measure is placed at the heel of the child's foot. C: The tape measure can be used in children who weigh up to 75 pounds. D: The resuscitation tape estimates a child's age based on his or her height.
answer
C: The tape measure can be used in children who weigh up to 75 pounds. Reason: There are a number of ways to identify the appropriate size equipment for a pediatric patient; however, the length-based resuscitation tape measure is perhaps the most accurate. Pediatricians generally agree that length (height), not age, is the most reliable estimator of weight. The resuscitation tape estimates a child's weight based on his or her height; it is a reliable tool to use in children who weigh up to 75 lb (34 kg). To use the resuscitation tape, lay it next to the child with the multicolored side up. Place the red end of the tape at the top (crown) of the child's head, and stretch the tape out the full length of the child, stopping at the heel of the foot. Place your free hand, side down, at the bottom of the child's heel. Note the color or letter and weight range on the edge of the tape where your hand is.
question
You are dispatched to a residence for a child having a seizure. When you arrive at the scene, the 4-year-old child's grandfather tells you that he has had several full body seizures over the past 20 minutes, but never woke up in between the seizures. The child's skin is hot and flushed. This is MOST indicative of: A: a febrile seizure. B: an absence seizure. C: a focal motor seizure. D: status epilepticus.
answer
D: status epilepticus. Reason: Status epilepticus is defined as a prolonged (greater than 20 minutes) seizure or multiple seizures without a return of consciousness in between seizures. A febrile seizure is caused by an abrupt rise in body temperature, usually due to a non-life-threatening infection (eg, middle ear infection). Most febrile seizures last less than 5 minutes, have resolved by the time EMS arrives at the scene, and are not followed by a postictal period. The child in this scenario, although febrile (hot, flushed skin), did not experience a seizure caused by fever alone; you should suspect other causes of fever and seizures, such as meningitis. An absence seizure, also called a petit mal seizure, is characterized by a blank stare and an absence of tonic-clonic motor activity. Like febrile seizures, absence seizures are usually of short duration and are not followed by a postictal period. A focal motor seizure is isolated to one part of the body, such as an extremity, but can progress to a generalized (full body) seizure.
question
Occasional, irregular breaths that may be observed in a cardiac arrest patient are called: A: agonal gasps. B: ataxic respirations. C: Biot respirations. D: Cheyne-Stokes respirations.
answer
A: agonal gasps. Reason: Occasional, irregular breaths, called agonal gasps, may be observed in some patients shortly after their heart stops beating. They occur when the respiratory center in the brain sends stray signals to the respiratory muscles. Agonal gasps are not adequate because they are infrequent and result in negligible tidal volume. Biot respirations are characterized by an irregular pattern, rate, and depth of breathing with intermittent periods of apnea; they are commonly associated with severe brain trauma. Ataxic respirations are ineffective, irregular breaths that may or may not have an identifiable pattern; they are also commonly associated with severe brain trauma. Cheyne-Stokes respirations are characterized by a crescendo-decrescendo pattern of breathing with a period of apnea between each cycle (fast, slow, apnea). Cheyne-Stokes respirations may occur in healthy people during certain phases of the sleep cycle; however, if they are grossly exaggerated or occur in a patient with a head injury, they are an ominous sign.
question
A patient experienced blunt chest trauma and has asymmetrical chest wall movement. This MOST likely indicates: A: accumulation of blood in both of the lungs. B: several ribs broken in numerous places. C: shallow breathing secondary to severe pain. D: decreased air movement into one lung.
answer
D: decreased air movement into one lung. Reason: Asymmetrical chest wall movement, when one side of the chest moves less than the other, indicates decreased air movement into one lung (eg, pneumothorax, hemothorax). Bleeding into both lungs and shallow breathing due to severe pain would likely cause decreased movement to both sides of the chest. If more than two ribs are fractured in several places, a free-floating (flail) segment of fractured ribs is created. This flail segment (not necessarily an entire half of the chest) collapses during inhalation and bulges during exhalation; this is called paradoxical chest movement.
question
Despite direct pressure, a large laceration continues to spurt large amounts of bright red blood. You should: A: apply pressure to the pulse point that is proximal to the injury. B: place additional dressings on the wound until the bleeding stops. C: elevate the extremity and apply a tight pressure dressing. D: apply a tourniquet proximal to the injury until the bleeding stops.
answer
D: apply a tourniquet proximal to the injury until the bleeding stops. Reason: You must control any and all external bleeding as soon as possible. In the case of arterial bleeding (ie, bright red blood is spurting from the wound), the patient will bleed to death if immediate action is not taken. In most cases, direct pressure will effectively control external bleeding. However, if the wound continues to bleed profusely despite direct pressure, you should apply a tourniquet proximal to the injury and tighten it until the bleeding stops. Packing additional dressings on a severe external hemorrhage will only cause the patient to continue to bleed externally into the dressings. Locating and applying adequate pressure to a proximal arterial pressure point is often difficult and time-consuming.
question
An unresponsive man has shallow, gurgling respirations at a rate of 8 breaths/min. Initial treatment should include: A: oropharyngeal airway insertion. B: positive-pressure ventilations. C: suctioning of the oropharynx. D: oxygen via nonrebreathing mask.
answer
C: suctioning of the oropharynx. Reason: Before breathing can be assessed, let alone managed, the airway must be cleared of any and all secretions. When you hear gurgling respirations, you should provide immediate suctioning of the oropharynx for up to 15 seconds. After the airway is clear, insert an oral or nasal airway and begin assisting his ventilations. Shallow respirations at a rate of 8 breaths/min will not produce adequate minute volume and will require ventilatory assistance. If the patient is continuously producing oral secretions, you should suction his airway for 15 seconds and then ventilate him for 2 minutes. Continue this alternating pattern until his airway is clear of secretions or an advanced airway device (ie, ET tube, multilumen airway, supraglottic airway) has been inserted.
question
When assessing a patient with a possible stroke, you should recall that: A: fibrinolytic therapy must be given within 6 hours following the stroke. B: the patient may be unable to communicate, but can often understand. C: right-sided weakness indicates a stroke in the right cerebral hemisphere. D: the majority of strokes involve bleeding into the brain tissue.
answer
B: the patient may be unable to communicate, but can often understand. Reason: Some patients who have had a stroke may be unable to communicate (expressive aphasia), but they can often understand what is being said around them; be aware of this possibility. Seventy-five percent of all strokes are caused by a blocked cerebral artery (ischemic stroke); strokes caused by a ruptured cerebral artery (hemorrhagic stroke) are less common. Because the left side of the brain controls the right side of the body and vice versa, right-sided weakness (hemiparesis) indicates a stroke in the left cerebral hemisphere. Some patients who have had a stroke may benefit from fibrinolytic (clot-buster) therapy; however, to be most effective, this treatment must be given within the first 3 hours following the onset of the stroke.
question
Which of the following is the MOST reliable indicator of a fracture to a spinal vertebra? A: Decreased grip strength in the upper extremities B: Lack of pain at the site of the injury C: Decreased movement on one side of the body D: Palpable pain at the site of the injury
answer
D: Palpable pain at the site of the injury Reason: Of the options listed, the presence of palpable pain (specifically, point tenderness directly over the injury site), is the most reliable indicator of an underlying vertebral fracture. In fact, point tenderness, second only to gross deformity, is the most reliable indicator of an underlying fracture to any bone.
question
During the rapid head-to-toe assessment of a patient with multiple injuries, you expose the chest and find an open wound with blood bubbling from it. You should: A: place a porous dressing over the wound. B: prevent air from entering the wound. C: stop your assessment and transport. D: apply high-flow supplemental oxygen.
answer
B: prevent air from entering the wound. Reason: A sucking chest wound (open pneumothorax) is a life-threatening condition that must be corrected immediately upon discovery. You must take immediate action to prevent air from entering the wound or the patient's condition may continue to deteriorate. Cover a sucking chest wound with an occlusive (non-porous) dressing and secure it on three sides. This will prevent air from entering the pleural space during inhalation. It is important to note, however, that when you cover the wound, you have converted it from an open pneumothorax to a closed pneumothorax. Therefore, you must closely monitor the patient; if signs of a tension pneumothorax develop (ie, worsened respiratory distress, cyanosis, signs of shock), lift the unsecured corner of the dressing to allow air to escape from the pleural space.
question
Your patient is a 75-year-old female who, according to her son, tripped on a throw rug and fell. The patient is conscious and alert, is sitting on the couch, and has a hematoma to her forehead. When you ask her what happened, her son interjects by saying, "I already told you, she tripped and fell." As you further question her, you find that she is hesitant to answer your questions and keeps looking at her son. You should: A: interview the patient and her son separately if possible. B: notify law enforcement and have the son removed. C: tell the son that you suspect his mother has been abused. D: ask the patient if someone hurt her intentionally.
answer
A: interview the patient and her son separately if possible. Reason: There are several indicators that suggest this patient's injury was intentionally inflicted: the son's interjection, her hesitance to answer your questions, and the fact that she keeps looking at her son. If possible, interview the patient and her son separately; doing say may reveal inconsistencies regarding the event, which would further increase your index of suspicion for abuse. You must not, however, accuse her son of abuse or insinuate such. If you are wrong, you could be liable for slander. At present, the son is not verbally or physically abusive; however, if he becomes abusive, you should notify law enforcement at once. Remember, you are legally obligated to report any suspicions of abuse or neglect to the emergency department physician. You should make every effort to convince the patient to consent to treatment and transport.
question
Which of the following is a more reliable indicator of perfusion in children than it is in adults? A: Respiratory rate B: Capillary refill C: Heart rate D: Blood pressure
answer
B: Capillary refill Reason: In children younger than 6 years of age, capillary refill time (CRT) serves as an excellent indicator of perfusion; it assesses oxygen delivery to the capillaries. As a person gets older, however, CRT becomes less reliable. It is important to remember that factors such as cold temperature can affect CRT. Early in shock, the heart and respiratory rates increase in an attempt to compensate for decreases in oxygen; this occurs in both children and adults. When these compensatory mechanisms fail, the blood pressure falls, and the patient enters a state of decompensated shock. For this reason, you should not rely upon a patient's blood pressure to determine overall perfusion; the blood pressure may be maintained, despite inadequate perfusion.
question
A man is experiencing a severe allergic reaction after being stung by a scorpion. He does not have his own epinephrine; however, his wife is allergic to bees and has a prescribed epinephrine auto-injector. You should: A: provide rapid transport and consider an ALS rendezvous. B: assist the patient with one half the usual dose of the wife's epinephrine. C: request an ALS unit to respond to the scene to administer epinephrine. D: assist the patient with the wife's prescribed epinephrine.
answer
A: provide rapid transport and consider an ALS rendezvous. Reason: If a patient does not have a prescribed epinephrine auto-injector and is experiencing a severe allergic reaction, you should administer supplemental oxygen, assist the patient's ventilations if needed, and transport without delay. Closely monitor the patient's airway and breathing status en route and coordinate an ALS rendezvous if possible. If you carry an epinephrine auto-injector on your ambulance and your protocols allow you to administer it, do so without delay. Otherwise, the ALS unit will be able to administer epinephrine via the intramuscular or intravenous route. Never assist a patient with a medication that is not prescribed to him or her specifically.
question
As you begin ventilating an unresponsive apneic man, you hear gurgling in his upper airway. Your MOST immediate action should be to: A: suction the patient's airway for no longer than 15 seconds. B: quickly turn the patient onto his side so secretions can drain. C: reposition the patient's airway and continue ventilations. D: squeeze the bag-mask device with less force and reassess.
answer
B: quickly turn the patient onto his side so secretions can drain. Reason: Gurgling in the airway indicates the presence of vomitus or other secretions. If this is noted, you should immediately turn the patient onto his side to allow the secretions to drain. After placing the patient on his side, suction his airway for no longer than 15 seconds. To continue ventilating a patient whose airway is full of vomitus or secretions will force the secretions into the trachea, resulting in aspiration. Aspiration significantly increases mortality!
question
A 22-year-old female woman was shot by her husband. Law enforcement is at the scene and has the husband in custody. The patient is conscious, but extremely restless, and is pale and diaphoretic. As your partner administers high-flow oxygen, you should: A: keep her warm by applying blankets. B: look for and control any bleeding. C: take her BP to detect hypotension. D: compare her carotid and radial pulses.
answer
B: look for and control any bleeding. Reason: The primary assessment of any patient includes ensuring a patent airway, assessing breathing adequacy, administering high-flow oxygen or assisting ventilations, assessing circulation, and controlling all active bleeding. You and your partner must work as a team; as your partner administers high-flow oxygen, you should be looking for her gunshot wound(s) and ensuring that all bleeding is controlled. After the primary assessment and management, begin treating her for shock (eg, applying a blanket, elevating her lower extremities [if local protocol permits]) and perform a rapid head-to-toe assessment to search for other injuries that may not have been obvious during the primary assessment. Assess the patient's vital signs after all life-threatening injuries or conditions have been identified and corrected.
question
A young woman reports significant weight loss over the last month, persistent fever, and night sweats. When you assess her, you note the presence of dark purple lesions covering her trunk and upper extremities. You should suspect: A: tuberculosis. B: HIV/AIDS. C: end-stage cancer. D: rheumatic fever.
answer
B: HIV/AIDS. Reason: Weight loss, fever, and night sweats could indicate tuberculosis or HIV/AIDS; however, the dark purple lesions on the skin, which are called Kaposi's sarcoma, are malignant skin tumors and are a classic finding in patients in the later stages of AIDS.
question
A middle-aged woman took three of her prescribed nitroglycerin tablets after she began experiencing chest pain. She complains of a bad headache and is still experiencing chest pain. You should assume that: A: her chest pain is not cardiac-related. B: she has ongoing cardiac ischemia. C: her nitroglycerin is no longer potent. D: her blood pressure is elevated.
answer
B: she has ongoing cardiac ischemia. Reason: A headache and/or a bitter taste under the tongue are common side effects of nitroglycerin (NTG) that many patients experience. If the patient does not experience these side effects, the NTG may have lost its potency. However, if a patient with chest pain takes NTG and experiences these side effects, but still has chest pain, you should assume that his or her pain is the result of cardiac ischemia, a relative deprivation of oxygen to the heart. NTG is a vasodilator drug; if anything, three doses would lower her blood pressure, not raise it. Any patient with nontraumatic chest pain or pressure should be assumed to be experiencing cardiac ischemia, especially if the pain or pressure is not relieved with NTG.
question
While caring for an injured patient, you remove blood-soaked clothing in order to treat his injuries. You should dispose of the clothing by: A: placing it in a biohazard bag. B: leaving it at the scene. C: placing it in a regular trash can. D: leaving it at the hospital.
answer
A: placing it in a biohazard bag. Reason: The appropriate method for disposing of soiled clothing or any other "nonsharp" contaminated item is to place it in a red biohazard bag. The biohazard insignia as well as the red color alerts others that the items within the bag are contaminated.
question
During which part of your assessment would you MOST likely discover a small caliber gunshot wound to the back with minimal bleeding? A: Detailed secondary assessment B: General impression C: Rapid head-to-toe assessment D: Primary assessment
answer
C: Rapid head-to-toe assessment Reason: During both the general impression and the primary assessment, you should assess for major bleeding. If there is no obvious bleeding, you should continue your assessment as usual. It is during the rapid head-to-toe assessment, when log rolling the patient to assess the posterior (back), that you would most likely find a small caliber gunshot wound, especially if there is little or no bleeding. A secondary assessment should be performed, and focuses primarily on the patient's chief complaint; however, this may not be practical on a critically ill or injured patient. If a secondary assessment is performed on a critically ill or injured patient, it should occur en route to the hospital. All bleeding should have been controlled long before performing a secondary assessment.
question
Which of the following injuries is MOST indicative of child abuse? A: Multiple bruises to the shins B: Bruising to the upper back C: Burned hand with splash marks D: Small laceration to the chin
answer
B: Bruising to the upper back Reason: In order to detect child abuse, you must be familiar with injury locations and patterns consistent with an accident versus those that were intentionally inflicted. It is common for children to trip, fall, and strike their chin or forehead on a solid object; therefore, chin lacerations and hematomas to the forehead are common injuries. Small children frequently hit their legs on coffee tables, resulting in bruises to the shins. If a child accidentally sticks his or her hand in hot water, the hand is quickly pulled back by reflex, resulting in a splash pattern of burns. Injuries found in anatomically unlikely areas, such as the torso (back or front), upper arms and legs, or genitalia, should raise your index of suspicion. Burns that are not accompanied by splash marks should also make you suspicious. For example, if a child's hand or foot is intentionally held in hot water, you will see a clear line of demarcation (stocking-glove effect) without evidence of splash burns.
question
In contrast to an incision, a laceration: A: usually involves an artery. B: is a jagged cut. C: bleeds more severely. D: is a superficial injury.
answer
B: is a jagged cut. Reason: A laceration is a jagged cut caused by a sharp object or a blunt force that tears the tissue, whereas an incision is a sharp, smooth cut. The depth of the injury can vary; it can extend through the skin and subcutaneous tissue or into the underlying muscles and adjacent nerves and blood vessels. Lacerations and incisions can involve arteries, veins, or both, potentially resulting in severe bleeding.
question
What is the function of pulmonary surfactant? A: It facilitates the production of mucous, which is expelled during coughing. B: It lubricates the alveolar walls and allows them to expand and recoil. C: It carries fresh oxygen from the lungs to the left side of the heart. D: It dilates the bronchioles in the lungs and enhances the flow of air.
answer
B: It lubricates the alveolar walls and allows them to expand and recoil. Reason: Surfactant is a lubricant that lines the alveolar walls. It allows them to expand and recoil freely, thereby allowing for an easy exchange of oxygen and carbon dioxide. Diseases such as emphysema cause destruction of the alveolar walls and a decrease in pulmonary surfactant. This makes the normal process of breathing very difficult for these patients. Mucous-producing cells, called Goblet cells, line the trachea and larger bronchi. Provided the patient has an effective cough reflex, bacteria and other pathogens can be expelled from the body via the mucous produced by the Goblet cells.
question
Which of the following signs would you expect to see in the early stages of shock? A: Restlessness B: Thready pulses C: Unconsciousness D: Hypotension
answer
A: Restlessness Reason: In the early stages of shock, decreased perfusion to the brain causes the patient to become restless and anxious. As shock progresses, the pulse becomes thready (weak), signifying a falling blood pressure (hypotension), and the patient eventually loses consciousness. It is critical to recognize the early signs of shock and initiate immediate care and rapid transport. You should not rely on the blood pressure as an indicator of perfusion in any patient; by the time hypotension manifests, the patient's compensatory mechanisms have failed and he or she is in decompensated shock.
question
Which of the following statements regarding artificial ventilation of an apneic patient who has dentures is correct? A: If a patient's dentures are loose, the EMT should use the jaw-thrust maneuver to keep the airway open. B: Tight-fitting dentures should be left in place because they facilitate the delivery of adequate tidal volume. C: Because of the risk of airway obstruction, the EMT should routinely remove a patient's dentures. D: The EMT should not attempt to remove a patient's dentures because this may cause an airway obstruction.
answer
B: Tight-fitting dentures should be left in place because they facilitate the delivery of adequate tidal volume. Reason: Providing artificial ventilation with a bag-mask or pocket face mask device is usually much easier when dentures can be left in place. Leaving the dentures in place provides "structure" to the face and will assist you in maintaining a good mask-to-face seal, thus facilitating the delivery of adequate tidal volume. However, loose dentures make it much more difficult to perform artificial ventilation by any method and can easily obstruct the airway. Therefore, dentures and dental appliances that do not stay firmly in place should be removed. When ventilating a patient who has dentures or a dental appliance, periodically reassess his or her airway to ensure they remain firmly in place.
question
In which of the following situations would external bleeding be the MOST difficult to control? A: Femoral artery laceration, BP of 140/90 mm Hg B: Jugular vein laceration, BP of 104/60 mm Hg C: Scalp laceration, BP of 130/70 mm Hg D: Carotid artery laceration, BP of 70/50 mm Hg
answer
A: Femoral artery laceration, BP of 140/90 mm Hg Reason: In general, the larger the size and type (eg, artery versus vein) of blood vessel injured, and the higher the patient's blood pressure, the more difficult the external bleeding will be to control. Of the choices listed, bleeding from a lacerated femoral artery (large, high-pressure vessel) in a patient with a blood pressure of 140/90 mm Hg (the highest BP listed) would be the most difficult to control. As a patient's blood pressure begins to fall, the driving force of blood in the arteries decreases and the bleeding becomes easier to control. Unfortunately, however, the patient is usually in decompensated shock at this point. The scalp contains many small blood vessels and tends to bleed heavily; however, direct pressure usually controls the bleeding with relative ease, regardless of the patient's blood pressure.
question
An inaccurate pulse oximetry reading may be caused by: A: excessive red blood cell production. B: heat illnesses, such as heat stroke. C: a heart rate greater than 100 beats/min. D: severe peripheral vasoconstriction.
answer
D: severe peripheral vasoconstriction. Reason: A pulse oximeter measures the percentage of hemoglobin that is saturated with oxygen. Under normal conditions, a patient's oxygen saturation (SpO2) ranges between 95% and 100% while breathing room air. Although no definitive threshold for normal SpO2 values exists, an SpO2 that is less than 95% in a nonsmoker may indicate hypoxemia. Of the factors listed, several peripheral vasoconstriction (ie, hypothermia, cigarette smoking, chronic hypoxia) would be the most likely to produce an inaccurate SpO2 reading. When the peripheral vasculature constricts, blood is shunted to the core of the body; in such cases, the pulse oximeter would likely yield a falsely low reading (or no reading at all). Other factors that can cause inaccurate readings include dark or metallic nail polish, dirty fingers, and abnormal hemoglobin binding (ie, carbon monoxide [CO] poisoning). It is important to note that the pulse oximeter is designed to detect gross abnormalities, not subtle changes, and should be used in conjunction with a thorough clinical assessment of the patient.
question
Upon arriving at the scene of a crash involving a large truck, you immediately note the presence of an orange placard on the side of the tank that the truck is pulling. This indicates that the vehicle is carrying a/an ______________ agent. A: radioactive B: corrosive C: flammable D: explosive
answer
D: explosive Reason: The color of a warning placard indicates the general classification of agent being carried, while the United Nations (UN) number in the center of the placard indicates the exact agent being carried. For example, a red placard bearing the UN number 1203 indicates gasoline; red indicates the classification (flammable), and 1203 indicates the exact agent (gasoline). Orange placards indicate explosive or blasting agents, placards that are half yellow and half white indicate radioactive agents, and black placards indicate corrosive agents. Use your emergency response guidebook (and binoculars, if appropriate) to identify both the classification and exact agent involved.
question
Prior to administering nitroglycerin to a patient with chest pain, you should: A: elevate the patient's lower extremities. B: inquire about an allergy to salicylates. C: obtain vital signs to detect hypotension. D: auscultate the patient's breath sounds.
answer
C: obtain vital signs to detect hypotension. Reason: Prior to assisting a patient with his or her prescribed nitroglycerin, there are two things that you must do: take the patient's vital signs and obtain authorization from medical control. Nitroglycerin is contraindicated for patients with a systolic blood pressure that is less than 100 mm Hg. If the patient develops hypotension after being given nitroglycerin, elevating his or her lower extremities would be indicated. Salicylates are a class of drugs that include aspirin, not nitroglycerin (nitroglycerin is a nitrate). Although you should inquire about medication allergies in general, it is not necessary to inquire specifically about an allergy to salicylates unless you are going to administer aspirin. Assessment of a patient with a possible cardiac or respiratory problem should include auscultation of breath sounds; however, this does not necessarily have to be done before assisting the patient with his or her nitroglycerin.
question
When restraining a violent patient, you should make sure that: A: consent for restraint has been obtained from a family member. B: someone talks to the patient during the process. C: at least two EMTs restrain the patient. D: the patient is restrained using maximal force.
answer
B: someone talks to the patient during the process. Reason: If a violent patient needs to be restrained, you must ensure the presence of at least four people (one per extremity). One of the EMTs should continuously talk to the patient to explain what is happening, even if the patient is not listening. Restraint is a last resort used to protect the EMT as well as the patient. Consent is not needed from a family member prior to restraining the patient. Just enough force to effectively restrain the patient is all that is required to prevent causing unnecessary injury.
question
When requesting medical direction for a patient who was involved in a major motor-vehicle accident, you should do all of the following, EXCEPT: A: describe the severity of damage to the patient's vehicle. B: question an order if it seems to be inappropriate. C: use radio codes to describe the situation. D: use proper medical terminology when speaking.
answer
C: use radio codes to describe the situation. Reason: When giving a report to medical control or requesting medical direction, you should avoid the use of radio codes, such as "10-50." The physician may not be familiar with such codes. There is clearly less risk of confusion if you use plain English. At the same time, you should use proper medical terminology, especially when describing the patient's injuries. Information regarding the severity of damage to the patient's vehicle is critical information and should be relayed to the physician; this can help him or her appreciate the significance of the situation. Do not be afraid to question an order that is contrary to your training or protocols; the physician may have simply made an error. Repeating an order back to the physician, word for word, will minimize the risk of this occurring.
question
During your assessment of a patient who experienced blunt facial trauma, you note the presence of a hyphema. This indicates: A: direct trauma to the eyeball. B: that the pupils are unequal. C: a fracture of the nasal bone. D: an orbital blowout fracture.
answer
A: direct trauma to the eyeball. Reason: Some patients with blunt trauma to the eyeball (globe) may present with a hyphema, or bleeding into the anterior chamber of the eye, that obscures a portion of or the entire iris. This condition may seriously impair vision and should be considered a sight-threatening emergency. A fracture of the orbital floor (blowout fracture) is characterized by double vision and an inability of the patient to move his or her eyes above the midline (paralysis of an upward gaze) following blunt facial trauma. In an orbital blowout fracture, fragments of fractured bone can entrap some of the muscles that control eye movement. Anisocoria is the term used to describe unequal pupils. Unequal pupils following head trauma indicates increased intracranial pressure.
question
Which of the following actions is MOST important when immobilizing a patient with a suspected spinal injury? A: Select and apply the appropriate size of extrication collar. B: A vest-style immobilization device should routinely be used. C: Secure the patient's head prior to immobilizing the torso. D: Check range of motion by asking the patient to move the head.
answer
A: Select and apply the appropriate size of extrication collar. Reason: Although an extrication (cervical) collar is not the sole means of immobilizing the patient's spine, it must be of the appropriate size in order to minimize flexion/extension of the patient's neck. When immobilizing any patient, whether with a vest-style device or long spine board, the head is immobilized after the torso. Immobilizing the head first may cause potential cervical spine compromise as the torso is immobilized. Determining whether to use a vest-style immobilization device or a long spine board is based on the patient's condition. Obviously, you should never ask a patient with a potential spinal injury to move his or her head around.
question
A 42-year-old man has a large knife impaled in the center of his chest. He is unresponsive, pulseless, and apneic. You should: A: carefully remove the knife, control the bleeding, and apply the AED. B: secure the knife in place with a bulky dressing and transport immediately. C: carefully remove the knife, control the bleeding, and begin CPR. D: stabilize the knife with bulky dressings, begin CPR, and transport at once.
answer
C: carefully remove the knife, control the bleeding, and begin CPR. Reason: Generally, impaled objects should be stabilized in place and not removed; however, if they interfere with the patient's airway or your ability to perform CPR, they must be carefully removed. The knife in this patient is impaled in the center of his chest (the precordium), which is where chest compressions are performed. Carefully remove the knife, control any external bleeding, begin CPR, and transport immediately. The AED is not indicated for victims of traumatic cardiac arrest. Massive blood loss is the most common cause of traumatic cardiac arrest, not a cardiac dysrhythmia; therefore, the AED would be of little benefit.
question
How can you help maximize cardiac output during CPR? A: Allow the chest to fully recoil in between compressions B: Compress the chest at a rate of no more than 100/min C: Deliver rescue breaths until the chest expands widely D: Ventilate the patient through an advanced airway device
answer
A: Allow the chest to fully recoil in between compressions Reason: Cardiac output is the amount of blood ejected from the left ventricle per minute. Bearing in mind that even the best performed CPR produces only between 25% and 30% of what the patient's cardiac output would otherwise be, there are several actions that you must take to help maximize this. Allowing the chest to fully recoil in between compressions will help draw blood back to the heart; if more blood returns to the heart, more blood can be pumped from the heart with chest compressions. Delivering each rescue breath over a period of 1 second, just enough to produce visible chest rise, will also help maximize cardiac output. If ventilations are given to fast or too forcefully, intrathoracic pressure will increase, resulting in a decrease in the amount of blood that returns to the heart; as a result, cardiac output will decrease. Ventilations are delivered no differently if an advanced airway device (ie, ET tube, multilumen airway, supraglottic airway) has been inserted. Deliver chest compressions at a rate of at least 100 per minute to a depth of at least 2" (at least one third the depth of the chest in infants and children).
question
Proper guidelines for safe reaching include all of the following, EXCEPT: A: reaching no more than 30" in front of your body. B: avoiding twisting of your back. C: avoiding hyperextension of your back. D: keeping your back in a locked-in position.
answer
A: reaching no more than 30" in front of your body. Reason: Safe reaching practices are critical to the prevention of a back injury. When reaching, you should keep your back in a locked-in position. You should avoid twisting or hyperextending your back, and should reach no more than 15 to 20 inches in front of your body.
question
Which of the following structures is NOT part of the endocrine system? A: Gallbladder B: Thyroid C: Pancreas D: Pituitary
answer
A: Gallbladder Reason: The gallbladder, which concentrates and stores bile, is not an endocrine organ; it is a digestive organ. Endocrine organs produce hormones, which regulate other body organs and systems. The thyroid regulates metabolism; the pancreas produces insulin and glucagon; and the pituitary gland, which is located within the brain, is the "master" endocrine gland and regulates the function of all endocrine glands in the body.
question
You arrive at a residence where you find a man lying unresponsive in his front yard. There were no witnesses to the event. In assessing this man, you should assume that he: A: is having a diabetic reaction. B: has sustained an injury. C: has a heat-related emergency. D: is having a heart attack.
answer
B: has sustained an injury. Reason: In the absence of any witnesses, you should assume that any patient who is found unresponsive has an injury until ruled out at the hospital. Apply spinal motion restriction precautions as needed. Do not be so hasty to label your patient as a "medical" or "trauma" patient. Many patients have injuries and medical conditions at the same time. For example, a patient can be driving his or her vehicle, experience a heart attack, and run off the road and strike a tree.
question
A 4-year-old girl fell from a third-story window and landed on her head. She is semiconscious with slow, irregular breathing and is bleeding from her mouth and nose. You should: A: suction her oropharynx, open her airway with the jaw-thrust maneuver, insert an oropharyngeal airway, and assist her ventilations. B: open her airway with the jaw-thrust maneuver while manually stabilizing her head, suction her oropharynx, and assist her ventilations. C: manually stabilize her head, open her airway with the jaw-thrust maneuver, insert a nasopharyngeal airway, and suction her oropharynx. D: open her airway by carefully tilting her head back, suction her oropharynx, and administer high-flow oxygen via nonrebreathing mask.
answer
B: open her airway with the jaw-thrust maneuver while manually stabilizing her head, suction her oropharynx, and assist her ventilations. Reason: In any semi- or unconscious patient with a head injury, you should manually stabilize the head and open the airway with the jaw-thrust maneuver. If there are any secretions in the mouth, suction the oropharynx. If possible, insert a simple airway adjunct. The patient in this scenario is semiconscious and likely has an intact gag reflex; therefore, you should not attempt to insert an oropharyngeal airway. Conversely, you should not insert a nasopharyngeal airway in patients with a head injury, especially if there is fluid or blood draining from the nose (a sign of a skull fracture). After ensuring a patent airway, you should turn your attention to the patient's breathing. Slow, irregular breathing will not provide adequate minute volume and should be treated with ventilatory assistance.
question
A middle-aged man was found floating facedown in a small pond. When you arrive at the scene, bystanders are present, but nobody has removed him from the water because they thought he was dead. After reaching the victim, you should: A: stabilize his head as you remove it from the water and open his airway by tilting his head back. B: float a buoyant backboard under him, remove him from the pond, and begin rescue breathing. C: move him to a supine position by rotating the entire upper half of his body as a single unit. D: grab him by his clothing, remove him from the pond, and assess for breathing and a pulse.
answer
C: move him to a supine position by rotating the entire upper half of his body as a single unit. Reason: After safely reaching a drowning victim, you should first turn him to a supine position by rotating the entire upper half of the body as a single unit; protect the cervical spine as you do this because a spinal injury cannot be ruled out. Open the patient's airway, without manipulating the neck, and begin rescue breathing while still in the water. Float a buoyant backboard under the patient, secure him to it, and remove him from the water. After removing the victim from the water, assess for a pulse. If the victim is pulseless, begin CPR, dry him off, and apply the AED as soon as possible.
question
Which of the following statements regarding the head tilt-chin lift maneuver is correct? A: It is the technique of choice for patients with potential spinal injury. B: It should be used on all unresponsive patients that you encounter. C: It should be used in conjunction with an appropriate airway adjunct. D: It can only be used in conjunction with an oropharyngeal airway.
answer
C: It should be used in conjunction with an appropriate airway adjunct. Reason: In an unresponsive patient without a suspected spinal injury, the head tilt-chin lift maneuver is the recommended method for opening the airway. To aid in maintaining a patent airway, an appropriate airway adjunct (ie, oral or nasal airway) should be used in conjunction with the head tilt-chin lift maneuver. When inserted properly, the oral or nasal airway will keep the tongue off of the posterior pharynx. You must remember that even once an airway adjunct has been placed, proper positioning of the head must be maintained until the airway is secured more definitively (ie, endotracheal intubation). If you suspect that the unresponsive patient has a spinal injury, the jaw-thrust maneuver should be used; however, if the jaw-thrust maneuver does not adequately open the patient's airway, the head tilt-chin lift maneuver should be used.
question
Which of the following is the MOST significant finding in a patient with a severe headache? A: Chest discomfort B: Abdominal tenderness C: Pain in both legs D: Unilateral weakness
answer
D: Unilateral weakness Reason: Unilateral weakness (weakness on one side of the body) is a clinically significant finding in a patient with a headache because it could indicate a stroke (ischemic or hemorrhagic). Abdominal, chest, and leg pain are not common complaints associated with a headache, although they should be noted and investigated if they are present.
question
Which of the following patients would be the LEAST likely to present with classic signs and symptoms of acute myocardial infarction? A: 59 year-old male with alcoholism and angina pectoris. B: 55-year-old female with COPD and frequent infections. C: 72-year-old female with diabetes and hypertension. D: 64-year-old male with renal disease and depression.
answer
C: 72-year-old female with diabetes and hypertension. Reason: Chest pain, pressure, or discomfort (usually lasting greater than 15 minutes) is present in the majority of patients experiencing acute myocardial infarction (AMI). Other common signs and symptoms include shortness of breath, nausea, and diaphoresis. However, elderly female patients—especially those with diabetes—are more likely to present with atypical or unusual signs and symptoms than any other patient population. Diabetic neuropathy—a degenerative nerve condition associated with diabetes—results in decreased sensitivity to pain; therefore, the patient may present without any pain or discomfort. Sometimes, the only presenting signs and symptoms of AMI are generalized weakness, fatigue, or fainting.
question
How should you treat an unresponsive, uninjured patient with respirations of 16 breaths/min and good chest expansion? A: Oropharyngeal suctioning and assisted ventilations B: Suctioning as needed and artificial ventilations C: Jaw-thrust maneuver and frequent suctioning D: Airway adjunct and oxygen via nonrebreathing mask
answer
D: Airway adjunct and oxygen via nonrebreathing mask Reason: After opening the airway of an unresponsive patient, an airway adjunct (oral or nasal airway) should be inserted to keep the tongue from occluding the posterior pharynx. Oral and nasal airways are used in conjunction with manual head positioning to help maintain a patent airway. Unresponsive patients who are breathing adequately (good rate, adequate depth [tidal volume]) should receive high-flow oxygen via nonrebreathing mask. The patient must be monitored closely for signs of inadequate breathing, which will require ventilatory assistance with a bag-mask device. Suction the oropharynx only if blood or other secretions are in the patient's mouth.
question
Which of the following assessment parameters is the MOST reliable when determining if a patient with a head injury is improving or deteriorating? A: systolic blood pressure. B: pupillary reaction. C: rate and depth of breathing. D: level of consciousness.
answer
D: level of consciousness. Reason: All of the options in this question are important parameters to monitor in a patient with a head injury. However, the single most reliable parameter is the patient's level of consciousness (LOC); a person's LOC indicates how the brain is functioning from a global perspective. It should be monitored frequently in order to determine whether the patient's condition is improving (ie, concussion), or deteriorating (ie, intracerebral hemorrhage). In general, level of consciousness serves as the most reliable indicator of perfusion.
question
The quickest way to reduce cardiac ischemia in a patient experiencing an acute coronary syndrome is to: A: sit or lay the patient down. B: elevate the patient's legs. C: give supplemental oxygen. D: keep the patient warm.
answer
A: sit or lay the patient down. Reason: Ischemia is defined as a relative lack of oxygen. In other words, relative to the body's demand for oxygen, its supply is reduced. The quickest way to reduce ischemia in a patient with an acute coronary syndrome, or ACS (eg, unstable angina, acute myocardial infarction) is to reduce the heart's demand for oxygen; simply having the patient cease any exertion and placing him or her in a sitting or lying position will quickly and effectively accomplish this. Although supplemental oxygen increases the oxygen content of the blood and is an important treatment for any patient with ACS, it does not reduce the body's demand for oxygen.
question
A patient overdosed on several drugs and is unresponsive with shallow breathing and facial cyanosis. As you continue your assessment, the patient suddenly vomits. You should: A: begin assisting his ventilations. B: turn the patient onto his side. C: suction his oropharynx at once. D: insert an oropharyngeal airway.
answer
B: turn the patient onto his side. Reason: The patient's airway must be clear of foreign bodies or secretions before it can be assessed or managed. If the patient begins to vomit, he must first be rolled onto his side to allow for drainage of the vomitus. Use suction to remove secretions after you have positioned him on his side. After the airway is clear, you should insert an appropriate airway adjunct (oral or nasal airway) and ensure adequate ventilation and oxygenation. In this patient, this involves assisting his ventilations with a bag-mask device.
question
Following an apparent terrorist attack, numerous patients present with shortness of breath and persistent coughing. A green haze is noted in the area in which the patients are located. Which of the following agents should you suspect they were exposed to? A: Chlorine (CL) B: Tabun (GA) C: V agent (VX) D: Phosgene oxime
answer
A: Chlorine (CL) Reason: The patient's signs and symptoms are indicative of a pulmonary (choking) agent, specifically chlorine (CL). Chlorine (CL) was the first chemical agent ever used in warfare. It has a distinct odor of bleach and creates a green haze when released as a gas. Initially, it produces upper airway irritation and a choking sensation. Later signs and symptoms include shortness of breath, chest tightness, hoarseness and stridor as the result of upper airway swelling, and gasping or persistent coughing. Phosgene, not to be confused with phosgene oxime (a blistering [vesicant] agent), is also a pulmonary (choking) agent. Tabun (GA) and V agent (VX) are examples of chemical nerve agents. Nerve agents are among the most deadly chemicals developed. Designed to kill large numbers of people with small quantities, nerve agents can cause cardiac arrest within seconds to minutes of exposure.
question
Which of the following statements regarding crowning is correct? A: It is safe to transport the patient during crowning if the hospital is close. B: Crowning represents the end of the second stage of labor. C: Crowning always occurs immediately after the amniotic sac has ruptured. D: Gentle pressure should be applied to the baby's head during crowning.
answer
D: Gentle pressure should be applied to the baby's head during crowning. Reason: Crowning occurs when the baby's head is visible at the vaginal opening; it is an obvious sign of delivery in progress. When crowning is observed, you should apply gentle pressure to the infant's head to prevent an explosive delivery. Care must be taken to avoid putting pressure on the fontanelles (the soft spots on the infant's head). Crowning represents the end of the first stage of labor and the beginning of the second stage; it does not always occur immediately after the amniotic sac has ruptured. If the infant's head is born and the amniotic sac is still intact, you need to pinch the thin membrane with your fingers, which will usually cause the sac to easily rupture, and then suction the infant's mouth and nose.
question
A 5-year-old child in compensated shock secondary to severe vomiting and diarrhea would be expected to have: A: a weakly palpable carotid pulse. B: slow, shallow respirations. C: strong, bounding radial pulses. D: a slow capillary refill time.
answer
D: a slow capillary refill time. Reason: Compensated shock in the infant or child is characterized by poor peripheral perfusion (eg, delayed [> 2 seconds] capillary refill time, weak peripheral pulses, pallor), tachycardia, and tachypnea. In compensated shock, the child's blood pressure is maintained and his or her mental status is adequate. In decompensated shock, the child's compensatory mechanisms have failed; blood pressure falls, central pulses become weak, and mental status begins to deteriorate. It is critical to recognize an infant or a child in compensated shock, begin immediate treatment, and transport without delay.
question
Law enforcement requests your assistance to evaluate a young female who they believe has overdosed. The patient is conscious, is displaying bizarre behavior, and is very restless. Her BP is 170/90 mm Hg and her heart rate is 130 beats/min. You see needle tracks on both of her arms. She is MOST likely under the influence of a: A: benzodiazepine. B: powerful narcotic. C: sedative-hypnotic. D: methamphetamine.
answer
D: methamphetamine. Reason: The needle tracks on the patient's arms indicate narcotic abuse, most likely heroin; however, her signs and symptoms are not consistent with those caused by a narcotic or any other central nervous system (CNS) depressant (eg, benzodiazepine [a sedative-hypnotic]). Signs of CNS depression include a decreased level of consciousness, hypoventilation, bradycardia, and hypotension. Her signs and symptoms are consistent with a sympathomimetic (upper) overdose. Sympathomimetic drugs mimic the effects of the sympathetic (fight or flight) nervous system; therefore, restlessness or hyperactivity, hypertension, tachycardia, and pupillary dilation are common findings in patients who overdose. Amphetamine and methamphetamine (eg, ice, speed, crack) are examples of sympathomimetics.
question
Assessment and treatment of a patient with severe abdominal pain should include: A: giving the patient small sips of water. B: administering supplemental oxygen. C: placing the patient in a supine position. D: vigorously palpating the abdomen.
answer
B: administering supplemental oxygen. Reason: Patients with severe abdominal pain should be given supplemental oxygen (in a concentration sufficient to maintain an SpO2 of greater than 94%) and immediate transport. Most patients with abdominal pain prefer to lie on their side with their knees drawn up into their chest (fetal position), which takes pressure off of the abdominal musculature and often affords them some relief. Vigorous palpation of the abdomen should be avoided as this will only cause the patient more pain; instead, gently palpate each of the four abdominal quadrants, palpating the most painful area last. Because the patient may become nauseated and vomit and the possibility that he or she may require surgery, do not give him or her anything to eat or drink.
question
While assessing a patient with chest pain, you note that his pulse is irregular. This indicates: A: acute myocardial infarction or angina pectoris. B: abnormalities in the heart's electrical conduction system. C: a dysfunction in the left side of the patient's heart D: high blood pressure that is increasing cardiac workload.
answer
B: abnormalities in the heart's electrical conduction system. Reason: An irregular pulse indicates abnormalities in the electrical conduction system of the heart. The electrical conduction system, beginning with the sinoatrial node as the primary pacemaker, is responsible for initiating the electrical impulses that stimulate the myocardium to contract. An irregular pulse could indicate potentially lethal arrhythmias that could result in cardiac arrest. You should document an irregular pulse and report this important finding to the emergency department.
question
You are dispatched to the scene of a motorcycle crash. Upon arrival, you find the patient lying facedown approximately 25 feet from his bike. He is not wearing a helmet and is moaning. You should: A: evaluate the status of his airway. B: stabilize his head manually. C: log roll him to a supine position. D: apply a cervical collar.
answer
B: stabilize his head manually. Reason: The mechanism of injury for this patient was significant. In his present position (prone), you cannot effectively assess his airway. Therefore, your first action should be to manually stabilize his head. Then, you must log roll him into a supine position, keeping his head in an in-line position. If possible, log roll him directly onto a long backboard. After the patient is supine, assess the status of his airway, assess his breathing adequacy, administer high-flow oxygen or begin assisted ventilations if needed, and continue with your primary assessment. Apply a cervical collar as soon as possible, but assess his posterior neck first.
question
A nonrebreathing mask is MOST appropriate to use on patients who: A: have an adequate rate and depth of breathing. B: are semiconscious and breathing shallowly. C: are breathing less than 12 times per minute. D: are cyanotic and have a low oxygen saturation.
answer
D: are cyanotic and have a low oxygen saturation. Reason: With the oxygen flow rate set at 15 L/min, the nonrebreathing mask can deliver an oxygen concentration of 90% or greater. Unlike the bag-mask or pocket mask devices, which deliver oxygen via positive pressure, the nonrebreathing mask delivers oxygen passively; therefore, the patient must have an adequate rate and depth (tidal volume) of breathing in order to open the one-way valve in the nonrebreathing mask and inhale oxygen from the reservoir bag. Shallow (reduced tidal volume) breathing, bradypnea (slow breathing), cyanosis, a low oxygen saturation, and a decreased level of consciousness are signs of inadequate breathing, and should be treated with some form of positive-pressure ventilation assistance.
question
While assisting a paramedic in starting an IV on a patient, you are inadvertently stuck by the contaminated needle while attempting to place it in the sharps container. You should: A: cease patient care immediately. B: hold the paramedic liable for the needle stick. C: seek medical care as soon as possible. D: notify your supervisor and request an HIV test.
answer
C: seek medical care as soon as possible. Reason: If you receive an exposure while providing patient care, you should notify your supervisor or designated infection control officer and seek medical care as soon as possible. However, this should be done after you have completed patient care. You will be tested for bloodborne pathogens such as HIV and hepatitis B, and based on the degree of exposure, the physician may suggest immediate treatment. The paramedic did not intentionally stick you with the needle; therefore, you cannot hold him or her liable. Careful and appropriate handling of needles and other sharps will reduce your risk of an accidental stick.
question
Following the initial steps of resuscitation, a newborn remains apneic and cyanotic. You should: A: begin ventilations with a bag-mask device. B: gently flick the soles of its feet for up to 60 seconds. C: immediately resuction its mouth and nose. D: start CPR if the heart rate is less than 80 beats/min.
answer
A: begin ventilations with a bag-mask device. Reason: The initial steps of newborn resuscitation, which are performed on all newborns following delivery, include drying, warming, positioning, suctioning, and tactile stimulation. If the newborn remains apneic after the initial steps of resuscitation, or has a heart rate less than 100 beats/min, you should begin positive-pressure ventilations (PPV) with a bag-mask device at a rate of 40 to 60 breaths/min. Continued tactile stimulation (eg, flicking the soles of the feet, rubbing the lateral thorax) of an apneic newborn wastes time; you must ventilate at once. If the newborn's heart rate is less than 60 beats/min despite effective PPV, you should begin chest compressions.
question
You should suspect physical abuse of a 4-year-old child if you observe: A: bruises to the anterior tibial area. B: purple and yellow bruises to the thighs. C: curious siblings who are watching you. D: that the child clings to his or her parent.
answer
B: purple and yellow bruises to the thighs. Reason: EMTs always must keep the possibility of child abuse in the back of their minds when dealing with an injured child. Signs that would indicate abuse include, but are not limited to, bruises in areas that are not likely to be injured, such as the thigh, back, and chest; multiple bruises in varying colors, indicating various stages of healing; conflicting stories among caregivers; injuries that are beyond the developmental abilities of the child, such as a 2-year-old child who has "fallen from her bicycle"; and cases in which the child does not look at the parents or cling to them as one would expect an injured child to do. Siblings of an abused child are typically not curious onlookers as they have become accustomed to the abusive environment. As an EMT, you have a legal obligation to report any and all cases of suspected child abuse. Never accuse anyone of abusing a child. If you are wrong, you could be held liable for slander.
question
A 30-year-old woman has an open deformity to her left leg and is in severe pain. She is conscious and alert, has a patent airway, and is breathing adequately. Your primary concern should be: A: covering the wound to prevent infection. B: controlling any external bleeding. C: assessing pulses distal to the injury. D: administering high-flow oxygen.
answer
B: controlling any external bleeding. Reason: Initial care for any open injury involves controlling external bleeding. Further care involves manually stabilizing the injury site; applying a sterile dressing to keep gross contaminants from entering the wound; assessing distal perfusion (eg, a pulse), motor, and sensory functions; and stabilizing the injury with an appropriate splint. The patient in this scenario is conscious, alert, has a patent airway, and is breathing adequately. Depending on other assessment findings, oxygen may be indicated. Your primary concern, however, should be to ensure that all external bleeding has been controlled.
question
Medications such as albuterol (Ventolin) relieve respiratory distress by: A: constricting the bronchioles in the lungs. B: contracting the smaller airways in the lungs. C: dilating the large mainstem bronchi of the airway. D: relaxing the smooth muscle of the bronchioles.
answer
D: relaxing the smooth muscle of the bronchioles. Reason: Medications such as albuterol (Ventolin) and metaproterenol (Alupent) are in a class of drugs called bronchodilators. They relax the smooth muscle found within the bronchioles in the lungs, which causes them to dilate. This effect opens the air passages and improves the patient's ability to breathe.
question
While caring for a trauma patient, blood splashes into an EMT's eyes. This is an example of: A: indirect contact. B: exposure. C: transmission. D: infection.
answer
B: exposure. Reason: Exposure occurs when an individual comes in direct contact with blood or other bodily fluids. Examples of direct exposure include blood splashing into the eyes or mouth and an accidental stick with a contaminated needle or other sharp object. Exposure does not always result in disease transmission and subsequent infection; that depends on whether the patient has an infectious disease. Routine use of standard precautions will afford the EMT the best protection from exposure to an infectious disease.
question
Which of the following yields the lowest minute volume? A: Respiratory rate of 16 breaths/min; tidal volume of 400 mL B: Respiratory rate of 12 breaths/min; tidal volume of 500 mL C: Respiratory rate of 14 breaths/min; tidal volume of 300 mL D: Respiratory rate of 10 breaths/min; tidal volume of 500 mL
answer
C: Respiratory rate of 14 breaths/min; tidal volume of 300 mL Minute volume is the amount of air moved through the lungs each minute, and is calculated by multiplying tidal volume and respiratory rate. Therefore, a respiratory rate of 14 breaths/min and a tidal volume of 300 mL would yield a minute volume of 4,200 mL (4.2 L), which is less than the sum of any of the other values listed. Minute volume is affected by tidal volume, respiratory rate, or both. An increase in tidal volume, respiratory rate, or both will cause an increase in minute volume. A decrease in tidal volume, respiratory rate, or both will cause a decrease in minute volume.
question
Immediately following a generalized seizure involving tonic-clonic activity, most patients: A: have a slow heart rate because of cardiac depression during the seizure. B: are unresponsive but gradually regain consciousness. C: return to a normal level of consciousness but cannot recall the event. D: experience prolonged apnea and require positive-pressure ventilations.
answer
B: are unresponsive but gradually regain consciousness. Reason: Most generalized (grand mal) seizures last 3 to 5 minutes and are followed by a lengthy (5 to 30 minutes) period called the postictal phase, in which the patient is unresponsive at first but gradually regains consciousness. During the seizure itself, the nervous system releases excess adrenaline (epinephrine); therefore, tachycardia, even after the seizure has stopped, is common. Apnea is common during a seizure; however, breathing usually resumes after the seizure has stopped. Many patients are tachypneic following a seizure; this is the body's attempt to eliminate excess carbon dioxide that accumulated in the blood during the seizure. Unlike grand mal seizures, petit mal seizures (also called absence seizures) can last for just a fraction of a minute, after which the patient fully recovers immediately with only a brief lapse of memory of the event.
question
A young male experienced a syncopal episode after working in the heat for several hours. He is conscious and alert; has cool, clammy skin; and complains of nausea and lightheadedness. You should: A: provide rapid cooling. B: give him cold water to drink. C: transport him on his side. D: advise him to go home and rest.
answer
C: transport him on his side. Reason: The patient is experiencing heat exhaustion and should be transported to the hospital for evaluation, especially since he experienced a syncopal episode (fainting). Because he is nauseated, he should not be given anything to drink and should be placed on his side during transport to prevent aspiration if he vomits. Loosen any restrictive clothing that may trap heat. Rapid cooling is indicated for patients with heatstroke, the signs of which include an altered mental status and hot, flushed skin (dry or moist).
question
You arrive at the scene of a 56-year-old man who collapsed. The patient's wife tells you that he suddenly grabbed his chest and then passed out. Your assessment reveals that he is apneic and pulseless. As your partner begins one-rescuer CPR, you should: A: prepare the AED for use. B: notify medical control. C: obtain a SAMPLE history. D: insert an airway adjunct.
answer
A: prepare the AED for use. Reason: Immediate treatment for a patient in cardiac arrest involves performing CPR and applying the AED as soon as possible. After applying the AED pads to the patient's chest (around your partner's compressing hands), analyze his cardiac rhythm, deliver a shock if indicated, and immediately resume CPR (starting with chest compressions). Management of the airway, including insertion of an airway adjunct, should occur during the 2-minute period of CPR in between cardiac rhythm analysis and defibrillation. While CPR is in progress, obtain as much of the patient's medical history from his wife as possible, and notify medical control when it is practical (ie, you have more help at the scene).
question
A patient who is experiencing an acute myocardial infarction: A: has chest pain or discomfort that does not change with each breath. B: often complains of a different type of pain than a patient with angina. C: often experiences relief of his or her chest pain after taking nitroglycerin. D: most often describes his or her chest pain as being sharp or tearing.
answer
A: has chest pain or discomfort that does not change with each breath. Reason: The type of chest pain or discomfort associated with acute myocardial infarction (AMI) is the same that is experienced by patients with angina pectoris (eg, dull, crushing, pressure, heaviness); thus, you cannot distinguish AMI from angina pectoris based solely on the type or quality of pain. Furthermore, the pain associated with AMI, like that of angina, often radiates to the arm, jaw, back, or epigastrium. Relative to other causes of chest pain or discomfort (eg, pleurisy, pneumothorax), the pain associated with AMI and angina does not worsen or improve when the patient takes a breath. Rest and nitroglycerin often relieve the pain associated with stable angina, but are less likely to relieve the pain associated with AMI.
question
When calling your radio report to the receiving hospital, you should: A: break your report into 60-second increments. B: include the patient's name. C: be brief, concise, and factual. D: only give your report to a physician.
answer
C: be brief, concise, and factual. Reason: A radio report should be brief, concise, and factual. It should include the patient's age and sex, his or her chief complaint, associated assessment findings, vital signs, treatment that you provided, and the patient's response to your treatment. Avoid speculative statements regarding the patient's condition; report only what you know to be fact. Longer radio reports should be broken into 30-second increments; after 30 seconds, pause and ensure the listener heard your previous traffic. The patient's name is not vital to your report; thus, there is generally no need to disclose it. Unless you are requesting medical direction, it is acceptable, and routine practice, to give your report to a registered nurse.
question
You are assessing a 40-year-old male with an apparent psychiatric crisis. According to the mans's wife, he has a history of depression and schizophrenia and takes Zoloft and Zyprexa. A police officer is present at the scene. The patient, who is obviously scared, tells you that he sees snakes everywhere. You should: A: tell him that you do not see any snakes, but they are obviously scaring him. B: advise him that you suspect he has not been compliant with his medications. C: let him know that it is important for him to be transported as soon as possible. D: let him know that going to the hospital will keep him safe from the snakes.
answer
A: tell him that you do not see any snakes, but they are obviously scaring him. Reason: When caring for any patient with a behavioral emergency, your primary responsibility is to yourself, to stay safe. The patient in this scenario, although scared, is not violent. In cases such as this, you should be prepared to spend extra time with the patient; it may take longer to assess, listen to, and prepare the patient for transport. Just because he is experiencing an acute crisis does not mean that he has not been taking his medications; to make that assumption is merely speculation on your part. You must be honest, reassuring, and nonjudgmental. Let the patient tell you how he or she is feeling in his or her own words, and acknowledge any auditory or visual hallucinations. Do not, however, play along with his or her hallucinations; this is cruel and only reinforces that what the patient is hearing or seeing is real.
question
When caring for any patient with a decreased level of consciousness, your primary concern should be the: A: patient's blood glucose level. B: possibility of a spinal injury. C: potential for airway compromise. D: possibility of a drug overdose.
answer
C: potential for airway compromise. Reason: Altered mental status could be caused by a high or low blood glucose level, drug overdose, or head injury, among other causes. Furthermore, the possibility of a spinal injury should be considered if the patient was injured. However, your primary concern should be the status of the patient's airway. Patients with a decreased level of consciousness are at risk for aspiration if vomiting occurs. Unless spinal trauma is present or the patient is breathing inadequately (eg, fast or slow rate, shallow breathing [reduced tidal volume]), place him or her in the recovery position to facilitate drainage if vomiting occurs. Remember this: no airway, no patient!
question
You are performing a secondary assessment on a severely injured patient while en route to a trauma center. During the assessment, you note that the patient's respiratory rate has increased. You should: A: repeat the primary assessment and treat as needed. B: count the number of respirations per minute. C: immediately notify the receiving facility. D: assess his oxygen saturation with a pulse oximeter.
answer
A: repeat the primary assessment and treat as needed. Reason: Any time a patient's condition deteriorates, such as your patient whose respirations have increased, you should immediately repeat the primary assessment and adjust your treatment accordingly. For example, a patient who initially had adequate breathing may now require assisted ventilation. After stabilizing the patient's condition, reassess his or her vital signs, including oxygen saturation, and notify the receiving facility.
question
You are assessing a middle-aged male who is experiencing respiratory distress. The patient has a history of emphysema and hypertension. He appears fatigued; has weak retractions; and labored, shallow breathing. Your MOST immediate action should be to: A: assist his ventilations with a bag-mask device. B: administer oxygen with a nonrebreathing mask. C: auscultate his breath sounds to detect wheezing. D: assess his oxygen saturation with a pulse oximeter.
answer
A: assist his ventilations with a bag-mask device. Reason: Your patient is NOT breathing adequately. He is fatigued; has weak retractions; and labored, shallow breathing. If you do not treat him immediately, he may stop breathing altogether. You should begin assisting his ventilations with a bag-mask device and high-flow oxygen. After initiating ventilatory assistance, attach the pulse oximeter to assess his oxygen saturation and auscultate his breath sounds. A nonrebreathing mask is appropriate for patients with difficulty breathing who are moving air adequately; this patient is not!
question
A 21-year-old man partially amputated his right arm when the chainsaw he was using to trim trees slipped. You can feel a weak radial pulse and his arm is cool to the touch. Dark red blood is flowing heavily from the wound. You should: A: apply bulky compression dressings to the wound and splint the extremity. B: carefully pack sterile dressings into the wound and fully splint the extremity. C: control the bleeding, manipulate the arm to improve circulation, and apply a splint. D: apply a tourniquet proximal to the injury and tighten it until the bleeding stops.
answer
A: apply bulky compression dressings to the wound and splint the extremity. Reason: When caring for a partially amputated extremity, control bleeding with bulky compression (pressure) dressings and splint the extremity to prevent further injury. If direct pressure does not immediately control the bleeding, however, a proximal tourniquet should be applied without delay. Never pack dressings into a wound; this may cause further damage and increases the risk of infection. Although your patient's radial pulse is weak, it is present and indicates blood flow distal to the injury. Do not manipulate his arm; doing so may lacerate or compress an artery and compromise distal circulation.
question
A patient with a mild foreign body airway obstruction: A: has progressive difficulty breathing. B: is typically not cyanotic. C: has a low oxygen saturation. D: presents with a weak cough.
answer
B: is typically not cyanotic. Reason: Patients with a mild (partial) airway obstruction are able to move adequate amounts of air, but will have varying degrees of respiratory distress. The patient can cough forcefully, although you may hear wheezing in between coughs. Because the patient is able to move air effectively, the level of oxygen in his or her blood remains adequate; therefore, cyanosis is typically absent. By contrast, the patient with a severe (complete) airway obstruction cannot move air effectively and cannot speak. If a cough is present, it is weak and ineffective. As the level of oxygen in the blood falls, cyanosis develops, oxygen saturation falls, and the patient's level of consciousness decreases. A foreign body airway obstruction, mild or severe, is an acute event that presents with an acute onset of difficulty breathing. Progressive (gradually worsening) difficulty breathing is more consistent with diseases such as congestive heart failure and pneumonia.
question
The presence of subcutaneous emphysema following blunt trauma to the anterior neck should make you MOST suspicious for a: A: ruptured esophagus. B: fractured larynx. C: pneumothorax. D: carotid artery injury.
answer
B: fractured larynx. Reason: Crushing or blunt trauma to the anterior neck can injure the trachea or larynx. Once the cartilages of the upper airway and larynx are fractured, they do not spring back to their normal position. Such a fracture can lead to loss of voice, airway obstruction, and leakage of air into the soft tissues of the neck. Air leakage into the soft tissues is called subcutaneous emphysema. Subcutaneous emphysema may also be observed in patients with a tension pneumothorax, although it is typically located in the chest. Esophageal rupture would likely present with difficulty swallowing (dysphagia) and vomiting blood (hematemesis). You should suspect injury to a carotid artery or jugular vein if you observe a rapidly expanding hematoma to the neck following blunt trauma.
question
Which of the following organs are contained within the right upper quadrant of the abdomen? A: Liver and spleen B: Stomach and gallbladder C: Liver and stomach D: Liver and gallbladder
answer
D: Liver and gallbladder Reason: The liver and gallbladder lie within the right upper quadrant of the abdomen. Most of the stomach is within the left upper quadrant, as is the entire spleen.
question
A 23-year-old male was struck across the face with a baseball bat. His eyes are swollen shut, he has massive facial bruising and deformities, and has blood in his mouth. Your MOST immediate concern should be: A: permanent vision loss. B: intracranial bleeding. C: spinal trauma. D: airway compromise.
answer
D: airway compromise. Reason: Few things will kill a patient quicker than a compromised (nonpatent) airway. Blood in a patient's mouth must be removed immediately. It may be aspirated into the lungs or, if clotted, obstruct the airway. Spinal trauma, intracranial bleeding, and vision loss are all possible in a patient with blunt trauma to the face; however, airway compromise is the most immediate life threat. Remember, treat what will kill your patient first.
question
Hypoglycemia and acute ischemic stroke can present similarly because: A: the majority of stroke patients have a history of diabetes. B: the most common cause of a stroke is hypoglycemia. C: they are both caused by low levels of glucose in the blood. D: both oxygen and glucose are needed for brain function.
answer
D: both oxygen and glucose are needed for brain function. Reason: Although stroke and hypoglycemia are two distinctly different conditions, their signs and symptoms are often similar. This is because the brain requires both oxygen and glucose to function normally. An acute ischemic stroke is caused by a lack of oxygen to a part of the brain due to a blocked cerebral artery, whereas hypoglycemia (low blood glucose level) deprives the entire brain of glucose. In either case, the patient presents with signs of impaired brain function (ie, slurred speech, weakness, altered mental status). Both conditions may lead to permanent brain damage or death if not treated promptly.
question
Sudden cardiac arrest in the adult population is MOST often the result of: A: respiratory failure. B: a cardiac dysrhythmia. C: an acute stroke. D: myocardial infarction.
answer
B: a cardiac dysrhythmia. Reason: Most cases of sudden cardiac arrest (SCA) in the adult (70% to 75%) are the result of a cardiac dysrhythmia, most commonly ventricular fibrillation (V-Fib). This fact underscores the importance of early defibrillation. Stroke, respiratory failure, and myocardial infarction can all cause cardiac arrest in the adult, but a cardiac dysrhythmia is more common.
question
Which of the following types of stroke would MOST likely present with a sudden, severe headache? A: Thrombotic B: Ischemic C: Embolic D: Hemorrhagic
answer
D: Hemorrhagic A stroke occurs when blood flow to a portion of the brain is interrupted. There are two types of stroke: ischemic and hemorrhagic, both of which are acute events. Hemorrhagic stroke is caused by a ruptured artery in the brain, resulting in intracerebral bleeding, cerebral ischemia, and increased intracranial pressure. A classic feature of a hemorrhagic stroke is a sudden, severe headache (indicates cerebral artery rupture) that is followed by rapid deterioration of the patient's condition. By contrast, ischemic stroke (accounts for approximately 80% of all strokes) occurs when a clot occludes a cerebral artery. If the clot forms locally, it is referred to as a thrombotic stroke; if the clot travels to the brain from another part of the body, it is referred to as an embolic stroke. Acute ischemic stroke typically presents with a sudden onset of confusion, facial droop, slurred speech, and weakness to one side of the body. A headache is uncommon in patients with acute ischemic stroke.
question
You are ventilating an apneic 50-year-old woman with a bag-mask device. After squeezing the bag and noting visible chest rise, you should: A: reopen the airway and ventilate again. B: squeeze the bag again in 3 seconds. C: suction the airway for up to 15 seconds. D: allow the patient to completely exhale.
answer
D: allow the patient to completely exhale. Reason: When ventilating an apneic patient, it is important to allow for complete exhalation. To do this, deliver each breath over 1 second, just enough to make the chest visibly rise, and then deliver the next breath 5 to 6 seconds later (3 to 5 seconds later for infants and children). Failure to allow for complete exhalation may cause the patient to retain carbon dioxide (carbon dioxide elimination occurs during exhalation) and may also impair venous return to the heart secondary to hyperinflation of the lungs. If you observe visible chest rise when you ventilate the patient, there is no need to reopen the airway. Suction the airway only if secretions are present.
question
General guidelines when assessing a 2-year-old child with abdominal pain and adequate perfusion include: A: examining the child in the parent's arms. B: separating the child from the parent to ensure a reliable examination. C: placing the child supine and palpating the abdomen. D: palpating the painful area of the abdomen first.
answer
A: examining the child in the parent's arms. Reason: If the child's condition is stable, the parent should be allowed to hold the child during the examination. This will minimize anxiety in the child and will make the assessment easier for you. In general, you should avoid separating the child and parents unless the child's condition warrants it. When assessing the abdomen of any patient, you should palpate the most painful area last.
question
A 28-year-old woman has severe lower quadrant abdominal pain. When assessing her abdomen, you should: A: encourage the patient to lie supine with her legs fully extended. B: ask her where the pain is located and palpate that area first. C: ask her where the pain is located and palpate that area last. D: auscultate for bowel sounds for approximately 2 to 5 minutes.
answer
C: ask her where the pain is located and palpate that area last. Reason: Assessment of a patient's abdomen includes asking where the pain is located and then palpating that area last. Palpating the painful area first may interfere with the rest of your assessment because of the significant pain the patient will be in. Bowel sounds are of little value in the field and generally are not included in the abdominal assessment. Patients with severe abdominal pain typically prefer to lie on their side with their knees drawn up into their chest (fetal position). Moving them from this position will aggravate their pain.
question
In which of the following situations would the EMT MOST likely deliver a baby at the scene? A: The hospital is 15 miles away and crowning is not present. B: The amniotic sac has ruptured and contractions occur regularly. C: Contractions are 8 to 10 minutes apart and irregular. D: A tornado has struck and blocked the only route to the hospital.
answer
D: A tornado has struck and blocked the only route to the hospital. Reason: The EMT should prepare for delivery at the scene when delivery is imminent or can be expected within a few minutes (eg, the mother feels the urge to push, contractions are 2 to 3 minutes apart and regular, crowning is present); when a natural disaster (eg, flood, fire, tornado) has occurred and your route to the hospital is blocked; and when transportation is not available (eg, mechanical malfunction of the ambulance). These are just some of the factors to consider when making that critical decision. Rupture of the amniotic sac and the onset of contractions signals the beginning of the first stage of labor; delivery is usually not imminent at this point and it is generally safe to transport.
question
A 19-year-old female has a closed, swollen deformity to her left forearm. You are unable to palpate a radial pulse and the skin distal to the injury is cold and pale. Several attempts to contact medical control have failed and you are approximately 45 miles away from the closest hospital. You should: A: apply an air splint to her forearm, keep her arm below the level of her heart, place an icepack over the injury, and transport. B: begin transport at once, gently manipulate her arm en route until distal circulation is restored, and apply an air splint. C: make one attempt to restore distal circulation by applying gentle manual traction in line with the long axis of the limb. D: splint her entire arm with rigid board splints, elevate the limb above the level of her heart, and transport immediately.
answer
C: make one attempt to restore distal circulation by applying gentle manual traction in line with the long axis of the limb. Reason: Cold, pale skin and an absent distal pulse indicates that blood flow distal to the injury is compromised. You should notify medical control, who will likely direct you to attempt to restore distal circulation. However, if you are unable to contact medical control and your transport time will be lengthy, you should make ONE attempt to restore distal circulation by applying gentle manual traction in line with the long axis of the limb. Be careful, as excessive manipulation can worsen the vascular problem. If you are unsuccessful after one attempt, splint the limb in the most comfortable position for the patient and transport at once. If distal circulation is restored, splint the limb in whatever position allows the strongest distal pulse. You should elevate the limb above the level of the heart to help minimize swelling. An icepack may also help reduce pain and swelling.
question
During your initial attempt to ventilate an unresponsive apneic patient, you meet resistance and do not see the patient's chest rise. You should: A: assume that a foreign body is blocking the airway. B: begin CPR, starting with chest compressions. C: suction the airway for no longer than 15 seconds. D: reposition the head and reattempt to ventilate.
answer
D: reposition the head and reattempt to ventilate. Reason: If your initial attempt to ventilate a patient is met with resistance and/or does not make the chest visibly rise, you should reposition the patient's head and reattempt to ventilate. In many cases, this simple action will open the airway and enable you to ventilate the patient. However, If both of your breaths are met with resistance and/or do not make the chest visibly rise, you should assume that a foreign body is obstructing the airway and begin chest compressions. The airway should be suctioned if secretions are present in the mouth; if oral secretions are not present, do not suction.
question
Which of the following is considered minimum personal protective equipment (PPE) when suctioning an unresponsive patient's airway? A: Gloves, head cover, and eye protection B: Gloves and full facial protection C: Gloves and a mask D: Gloves, gown, and eye protection
answer
B: Gloves and full facial protection Reason: You should wear gloves when assessing or treating any patient. The level of personal protective equipment (PPE) used beyond gloves is dictated by the risk and type of exposure. When managing a patient's airway (eg, suctioning, ventilating with a bag-mask device), you should use, at a minimum, gloves and full facial protection. This will protect you from oral and eye exposure if the patient coughs or vomits. A gown should be worn, in addition to gloves and full facial protection, any time there is a risk of blood splatter. Examples of when this may occur include delivering a baby or caring for a combative patient with severe external bleeding. The level of PPE you use in a given situation should be guided by reasonable judgment and common sense.
question
Which of the following injury mechanisms is associated with hangings? A: Hyperextension B: Subluxation C: Distraction D: Axial loading
answer
C: Distraction Reason: Injury to the cervical spine following a hanging occurs via distraction, or stretching, of the vertebrae and spinal cord. A subluxation is a partial or incomplete dislocation; it is an injury, not an injury mechanism. Injuries related to hyperextension mechanisms are common in patients who strike their head on the windshield during a motor-vehicle crash. Axial loading is a mechanism of injury in which the spinal column is compressed vertically. Injuries caused by axial loading include cervical spine injuries after diving head first into shallow water and lumbar spine injuries after a fall from a significant height in which the patient lands feet first.
question
Treatment for a patient with congestive heart failure and shortness of breath may include: A: up to three doses of sublingual nitroglycerin. B: prophylactic suctioning of the airway. C: hyperventilation with a bag-mask device. D: supine positioning and elevation of the legs.
answer
A: up to three doses of sublingual nitroglycerin. Reason: Treatment for patients with congestive heart failure (CHF) includes supplemental oxygen as needed to maintain an oxygen saturation equal to or greater than 94%, continuous positive airway pressure (CPAP), ventilatory assistance with a bag-mask device if needed (do NOT hyperventilate the patient), placing the patient in an upright or sitting position to facilitate breathing (a supine position will clearly make it more difficult to breathe), monitoring the patient's vital signs, and transporting to the hospital without delay. Suction the airway only if there are secretions in the mouth; prophylactic suctioning is not indicated. Nitroglycerin (NTG) may be of value if the patient is not hypotensive and he or she has the medication prescribed to him or her. As a vasodilator, NTG causes systemic venous pooling of blood, which reduces the amount of blood returned to the heart (preload), and thus, the amount of blood available to backup in the lungs. Follow your local protocols or contact medical control as needed regarding the use of NTG for patients with CHF.
question
The MOST important initial steps of assessing and managing a newborn include: A: keeping the infant warm and counting respirations. B: clearing the airway and keeping the infant warm. C: suctioning the airway and obtaining a heart rate. D: drying and warming the infant and obtaining an APGAR score.
answer
B: clearing the airway and keeping the infant warm. Reason: In the initial steps of assessing and managing the newborn, the most important aspects include clearing the airway of amniotic fluid and making sure that the baby stays warm. The APGAR score should not be relied on as the initial indicator for resuscitation because it is not performed until the child is 1 minute old. Clearly, this is too long to wait before assessment and intervention. After the airway has been cleared and the newborn has been warmed, the respirations, heart rate, color, and oxygen saturation (SpO2) should be assessed and managed accordingly.
question
Following administration of nitroglycerin to a man with crushing chest pressure, he experiences a significant increase in his heart rate. This is MOST likely the result of: A: coronary vasoconstriction. B: a cardiac dysrhythmia. C: preexisting hypertension. D: a drop in blood pressure.
answer
D: a drop in blood pressure. Reason: Nitroglycerin (NTG) is a vasodilator drug. It dilates not only the coronary arteries, but also other arteries in the body. In some patients, NTG may cause a drop in blood pressure, especially if they are taking other medications that cause vasodilation (eg, erectile dysfunction drugs [Viagra, Levitra, Cialis]). In response to a drop in blood pressure, the nervous system attempts to compensate by increasing the heart rate (tachycardia). Common side effects of NTG include a headache, a burning sensation under the tongue, or a bitter taste in the mouth. Always assess the patient's vital signs, before and after administering nitroglycerin.
question
A 42-year-old male presents with fever, a severe headache, and a stiff neck. He is conscious, but confused. His wife tells you that he does not have any medical problems and does not take any medications. You should be MOST suspicious for: A: tuberculosis. B: meningitis. C: influenza. D: acute stroke.
answer
B: meningitis. Reason: Meningitis is an inflammation of the protective coverings of the brain and spinal cord (meninges). Common signs and symptoms of meningitis include fever, headache, neck stiffness (nuchal rigidity), and vomiting. An altered mental status is common in severe cases. Meningococcal meningitis, caused by a bacterium, is the most contagious and potentially fatal type of meningitis. The patient's signs and symptoms are not consistent with acute stroke, tuberculosis (TB), or influenza (the flu). Although fever is common with both TB and the flu, neither causes neck stiffness. Acute stroke may be associated with a headache, especially a hemorrhagic stroke; however, stroke patients typically do not have a fever.
question
Proper body mechanics when lifting and moving a patient include: A: using the muscles of your lower back to lift. B: keeping the weight as close to you as possible. C: twisting at the waist when moving around a corner. D: maintaining a slight curvature of your back.
answer
B: keeping the weight as close to you as possible. Reason: General guidelines for safe lifting and moving include keeping the weight as close to your body as possible; keeping your back in a straight, locked-in position; using the muscles of your thighs to lift; and avoiding twisting when moving a patient around a corner. Back injuries are the most common injury sustained by the EMT and can be easily avoided if proper lifting and moving techniques are observed.
question
You should suspect that your patient has pulmonary edema if he or she: A: is hypertensive and tachycardic. B: has swollen feet and ankles. C: has a dry, nonproductive cough. D: cannot breathe while lying down.
answer
D: cannot breathe while lying down. Reason: Pulmonary edema is often caused by failure of the left side of the heart. When the patient is lying down, he or she experiences worsened difficulty breathing (orthopnea) because more blood backs up in the lungs. Patients with severe pulmonary edema often produce pink, frothy sputum when they cough; this is another sign of blood backing up in the lungs. A dry, nonproductive cough is not common. Hypertension and tachycardia are common in patients with pulmonary edema; however, many other conditions can cause these findings. Swelling of the feet and ankles is commonly seen in patients with right heart failure, and occurs when blood backs up beyond the right atrium; it is not a common sign of left heart failure and pulmonary edema.
question
A patient presents with severe bradycardia, hypersalivation, vomiting, and excessive tearing. Which of the following agents would MOST likely cause his signs and symptoms? A: Soman B: Anthrax C: Phosgene D: Chlorine
answer
A: Soman Reason: Nerve agents (eg, V agent [VX], sarin [GB], soman [GD], tabun [GA]) are among the most deadly chemicals developed. Designed to kill large numbers of people with small quantities, nerve agents can cause cardiac arrest within seconds to minutes of exposure. Nerve agents, discovered while in search of a superior pesticide, are in a class of chemical called organophosphates, which are found in household bug sprays, agricultural pesticides, and some industrial chemicals. Organophosphates block an essential enzyme in the nervous system, which cause the body's organs to become overstimulated. The mnemonic "DUMBELS" can help you recall the signs and symptoms of nerve agent exposure; it stands for Diarrhea; Urination; Miosis (constricted pupils); Bradycardia; Emesis (vomiting), Lacrimation (excessive tearing); and Seizures, Salivation, and Sweating. You can also use the mnemonic "SLUDGEM," which stands for Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis, and Miosis.
question
A football player complains of severe neck pain and tingling in his arms and legs after being tackled. He is conscious and alert, has a patent airway, and is breathing adequately. He is in a supine position and is still wearing his helmet, which is tight-fitting. The MOST appropriate treatment for this patient includes: A: manually stabilizing his head, leaving his helmet on, applying a vest-style spinal immobilization device, placing him onto a long backboard, and restricting spinal motion with straps and a lateral head stabilizer. B: manually stabilizing his head with his helmet still on, removing the face mask, administering high-flow oxygen, placing him onto a long backboard, and restricting spinal motion with straps and a lateral head stabilizer. C: carefully removing his helmet, manually stabilizing his head, applying a cervical collar, administering high-flow oxygen, placing him onto a long backboard, and restricting spinal motion with straps and a lateral head stabilizer. D: manually stabilizing his head, carefully removing his helmet, administering high-flow oxygen, applying a cervical collar, placing him onto a long backboard, and restricting spinal motion with straps and a lateral head stabilizer.
answer
B: manually stabilizing his head with his helmet still on, removing the face mask, administering high-flow oxygen, placing him onto a long backboard, and restricting spinal motion with straps and a lateral head stabilizer. Reason: A helmet that fits well prevents the patient's head from moving and should be left on, provided (1) there are no impending airway or breathing problems, (2) it does not interfere with your assessment and treatment of airway or ventilation problems, and (3) you can properly immobilize the spine. You should also leave the helmet on if there is any chance that removing it will further injure the patient. The mask on most sports helmets can be removed, without affecting helmet position or function, by using a trainer's tool designed for cutting retaining clips or unscrewing the retaining clips for the face mask. Your patient has severe neck pain and tingling in his extremities; these are obvious signs of a spinal injury. However, he is conscious and alert, has a patent airway, and is breathing adequately. Thus, the safest approach is to remove the face mask as previously described, apply high-flow oxygen, and restrict spinal motion by securing him to a long backboard. A vest-style device is more suitable for seated patients; it is impractical to use on supine patients.
question
Which of the following patients has signs of inadequate breathing? A: A 30-year-old man with respirations of 12 breaths/min with adequate depth B: A 41-year-old woman with shallow respirations of 14 breaths/min C: A 60-year-old man with clear and equal breath sounds bilaterally D: A 50-year-old woman with respirations of 12 breaths/min and pink, dry skin
answer
B: A 41-year-old woman with shallow respirations of 14 breaths/min Reason: Although the 41-year-old woman has a respiratory rate that falls within the normal range for an adult, the depth of her breathing is shallow (reduced tidal volume). Signs of inadequate breathing in the adult include a slow (less than 12 breaths/min) or fast (greater than 20 breaths/min) respiratory rate, shallow depth (reduced tidal volume), altered level of consciousness, tachycardia, an irregular pattern of inhalation and exhalation, diminished breath sounds during auscultation, and cyanosis. It is important to assess ALL components of a patient's breathing: rate, regularity, depth, and quality. Do not rely solely on one parameter.
question
By which of the following mechanisms does nitroglycerin relieve cardiac-related chest pain or discomfort? A: Vasoconstriction and increased cardiac oxygen demand B: Vasodilation and increased myocardial oxygen supply C: Vasodilation and decreased myocardial oxygen supply D: Vasoconstriction and increased myocardial workload
answer
B: Vasodilation and increased myocardial oxygen supply Reason: Nitroglycerin is a smooth muscle relaxant. Smooth muscle is found within the walls of the blood vessels. Nitroglycerin causes vasodilation, including dilation of the coronary arteries, which in turn increases the flow of oxygenated blood to the heart and reduces myocardial workload. However, care must be taken when administering nitroglycerin to a patient. Because of its vasodilatory effects, nitroglycerin can cause hypotension; therefore, it should not be given to patients with a systolic blood pressure of less than 100 mm Hg.
question
A 56-year-old man has labored, shallow breathing at a rate of 28 breaths/min. He is responsive to pain only. You should: A: insert a nasopharyngeal airway and begin assisting his ventilations. B: place him on his side and administer oxygen via nonrebreathing mask. C: ventilate him with a bag-mask device at a rate of 30 breaths/min. D: suction his mouth for 15 seconds and insert an oropharyngeal airway.
answer
A: insert a nasopharyngeal airway and begin assisting his ventilations. Reason: This patient in this scenario is not breathing adequately. He is responsive to pain only, and his respirations are rapid, labored, and shallow. You should insert a nasopharyngeal airway, which is usually well-tolerated in patients who are semiconscious and have a gag reflex, and assist his ventilations with a bag-mask device. When assisting a patient's breathing, you should squeeze the bag-mask device to ensure that he or she receives 10 to 12 adequate breaths per minute. Do not hyperventilate the patient as this increases the risks of vomiting and aspiration. Hyperventilation also increases intrathoracic pressure, which may impair venous return to the heart (preload) and cause a decrease in cardiac output. Oxygen via nonrebreathing mask is appropriate for patients who are breathing adequately, but are suspected of being hypoxic. The recovery position (patient is placed on his or her side) is appropriate for unresponsive, uninjured patients with adequate breathing.
question
You receive a call for a 49-year-old woman who passed out. The patient's husband tells you that they were watching TV when the incident occurred. No trauma was involved. The patient is semiconscious and has cyanosis to her lips. After opening her airway with the head tilt-chin lift maneuver, you should: A: insert a nasopharyngeal airway. B: begin ventilation assistance. C: insert an oropharyngeal airway. D: assess her respiratory effort.
answer
A: insert a nasopharyngeal airway. Reason: In the absence of trauma, open the patient's airway with the head tilt-chin lift maneuver. To help maintain airway patency, a nasopharyngeal airway should be inserted. Your patient is semiconscious, not unconscious, so she will likely gag if you attempt to insert an oropharyngeal airway; this may result in aspiration if she vomits. Remember, you must first open the patient's airway and, if needed, suction any secretions from the mouth. Next, insert an airway adjunct and assess respiratory effort. The method of oxygenation you provide depends on the adequacy of the patient's breathing.
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When applying a vest-style spinal immobilization device to a patient with traumatic neck pain, you should: A: immobilize the head prior to securing the torso straps. B: ask the patient to fully exhale as you secure the torso. C: secure the torso section prior to immobilizing the head. D: gently flex the head forward as you position the device.
answer
C: secure the torso section prior to immobilizing the head. Reason: When you apply a vest-style immobilization device such as a KED, you must immobilize the patient's head after the torso is adequately secured. If you immobilize the head first, the cervical spine may be unnecessarily manipulated as you secure the torso. Prior to securing the torso straps, you should ask the patient to inhale as much as possible so that when the straps are secured, enough space is allowed for the patient to breathe adequately. After full immobilization, the patient's spine should be completely in-line, from the head to the pelvis. During the entire immobilization procedure, the patient's head must be maintained in a neutral in-line position.
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Which of the following would MOST likely occur if an adult patient is breathing at a rate of 45 breaths/min with shallow depth? A: Most of his or her inhaled air will not go beyond the anatomic dead space. B: Alveolar minute volume would increase due to the rapid respiratory rate. C: The lungs would become hyperinflated, potentially causing a pneumothorax. D: The volume of air that reaches the alveoli would increase significantly.
answer
A: Most of his or her inhaled air will not go beyond the anatomic dead space. Reason: Alveolar minute volume, the amount of air that reaches the alveoli per minute and participates in pulmonary respiration, is affected by tidal volume, respiratory rate, or both. If the respiratory rate decreases, tidal volume must increase in order to maintain adequate alveolar minute volume. Conversely, if tidal volume decreases, the respiratory rate must increase accordingly. However, if the respiratory rate is extremely fast, especially if the depth of breathing is shallow (reduced tidal volume), most of the inhaled air will only make it to the anatomic dead space (ie, trachea, larger bronchi) before it is promptly exhaled. As a result, alveolar minute volume would decrease, resulting in inadequate pulmonary respiration and hypoxia. For this reason, patients with rapid, shallow breathing often require ventilation assistance. Pulmonary hyperinflation would not be an issue in a patient with exceedingly fast breathing and reduced tidal volume because very little air is actually reaching the lungs.
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Immediately following a generalized motor seizure, most patients are: A: apneic. B: hyperactive. C: confused. D: awake and alert.
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C: confused. Reason: After a generalized (grand mal) motor seizure, the patient typically will be confused, sleepy, or in some cases, combative. This is referred to as the postictal phase. The patient's level of consciousness typically improves within 30 minutes. In many cases, the patient's respirations will be fast (tachypnea) following a seizure; this is the body's attempt to eliminate excess carbon dioxide that accumulated in the blood during the seizure.
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Which of the following patients is the BEST candidate for the administration of nitroglycerin? A: A woman who has taken three doses of prescribed nitroglycerin without relief of chest pain B: A woman with chest pain, prescribed nitroglycerin, and a blood pressure of 104/76 mm Hg C: A man with chest pain, expired nitroglycerin spray, and a blood pressure of 110/80 mm Hg D: An elderly man with crushing substernal chest pain and a blood pressure of 80/60 mm Hg
answer
B: A woman with chest pain, prescribed nitroglycerin, and a blood pressure of 104/76 mm Hg Reason: Nitroglycerin should be administered to patients who have the prescribed, unexpired drug with them and a systolic blood pressure of greater than 100 mm Hg. No more than three (3) nitroglycerin tablets or sprays should be administered to a patient in the prehospital setting. An expired medication should never be administered to any patient, even if the medication is otherwise indicated for his or her condition.
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Your actions at the scene of a critically injured patient who was shot during a robbery should include: A: caring for the patient while manipulating the scene minimally. B: starting immediate care as you would with any other patient. C: performing a primary assessment only. D: providing care when the police authorize you to.
answer
A: caring for the patient while manipulating the scene minimally. Reason: After ensuring your own safety, your priority while functioning at a crime scene is to provide care to the patient. However, you should make a reasonable effort to avoid manipulating the scene in order to preserve potential evidence. If furniture or other objects do not need to be moved to gain access to the patient and provide adequate working space, they should be left in place. Conversely, if any obstacles impede your care of the patient, they must be moved as needed. Seeking law enforcement approval before treating a critically injured patient would clearly waste valuable time.
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Supplemental oxygen via the blow-by technique is MOST appropriate for a child who presents with respiratory difficulty and: A: has facial cyanosis and a decreased level of consciousness. B: is breathing with a significant reduction in tidal volume. C: is agitated, tachycardic, and clinging to his or her parent. D: has a heart rate of 70 beats/min and signs of physical exhaustion.
answer
C: is agitated, tachycardic, and clinging to his or her parent. Reason: If a child presents with respiratory difficulty, the method of oxygen delivery depends on his or her mental status, respiratory effort, and heart rate. A child with respiratory distress has an increased work of breathing, is agitated and tachycardic, and is clinging to his or her parent. Oxygen for a child with respiratory distress should be given by the least threatening method. You should avoid further agitation of the child, which may cause deterioration of his or her condition. Give the child oxygen via the blow-by technique; allow the parent to hold the mask or oxygen tubing near the child's face. By contrast, respiratory failure in the child is characterized by a decreased level of consciousness, signs of physical exhaustion, reduced tidal volume (shallow breathing), cyanosis, and bradycardia. Children with respiratory failure need assisted ventilation with a bag-mask device and high-flow oxygen. Remember, respiratory failure is the most common cause of cardiac arrest in infants and children.
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A child typically begins to develop stranger anxiety when he or she is a/an: A: toddler. B: neonate. C: preschooler. D: infant.
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A: toddler. Reason: A toddler is a child between 1 and 3 years of age. During this period, children begin to walk and explore their environment. They are able to open doors, drawers, boxes, and bottles. Because they are explorers by nature and are not afraid, injuries in this age group increase. Stranger anxiety also develops early in this period. Toddlers often resist separation from caregivers and are afraid to let others come near them.
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A 21-year-old male was bitten on the left forearm by a dog. He is conscious and alert and denies any other injuries. An animal control officer is at the scene and has contained the dog. Your assessment of the patient's arm reveals a large avulsion with a peeled back flap of skin. Distal circulation is adequate and the patient is able to feel and move his fingers. In addition to bleeding control, you should: A: apply oxygen via a nonrebreathing mask. B: irrigate the wound for at least 15 minutes. C: perform a rapid head-to-toe assessment. D: replace the avulsed flap to its original position.
answer
D: replace the avulsed flap to its original position. Reason: An avulsion is an injury that separates various layers of soft tissue, usually between the subcutaneous layer and fascia, so that they become completely detached or hang as a flap. The patient's injury is isolated and not life-threatening; therefore, a rapid head-to-toe assessment is not indicated. Unless your protocols specify otherwise, oxygen is usually not necessary for patients with isolated, non-life-threatening soft tissue injuries. If the avulsed tissue is hanging from a small piece of skin, circulation through the flap may be at risk. If you can, replace the avulsed flap to its original position, as long as it is not visibly contaminated with dirt and/or other foreign materials, and then cover the wound with a dry sterile dressing. Unless the wound is grossly contaminated with dirt or debris, irrigation is usually deferred until the patient is evaluated by a physician. Furthermore, flushing an open wound may force dirt or other debris into the wound, increasing the risk of infection.
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Which of the following statements regarding pediatric anatomy is correct? A: The child's trachea is more rigid and less prone to collapse. B: Relative to the overall size of the airway, a child's epiglottis is smaller. C: The occiput is proportionately larger when compared to an adult. D: Airway obstruction is common in children because of their large uvula.
answer
C: The occiput is proportionately larger when compared to an adult. Reason: Compared to adults, infants and small children have a proportionately larger head, specifically the occiput (back of the head). Therefore, when positioning an infant or a child's airway, padding in between the shoulder blades is often needed to maintain neutral alignment of the head. Infants and children are at risk for an airway obstruction because their entire airway is smaller, not because their uvula is large. An infant or a child's trachea is less rigid than an adult's; therefore, it collapses more easily during respiratory distress. Relative to the overall size of an infant or a child's airway, the epiglottis is larger; it is also floppier.
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The function of the uterus is to: A: provide a cushion and protect the fetus from infection. B: dilate and expel the baby from the cervix. C: house the fetus as it grows for 40 weeks. D: provide oxygen and other nutrients to the fetus.
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C: house the fetus as it grows for 40 weeks. Reason: The uterus is a muscular organ where the fetus grows for 37 to 42 weeks (average of 40 weeks). It is responsible for contracting during labor, which in conjunction with dilation of the cervix (the opening of the uterus), expels the baby from the uterus into the birth canal. The placenta is the organ of exchange that delivers oxygen and other nutrients from the mother to the fetus and returns metabolic waste products from the fetus to the mother. The amniotic sac, also called the bag of waters, provides a cushion for the developing fetus and helps protect it from infection.
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Your assessment of a mother in labor reveals that a fetal limb is protruding from the vagina. Management of this situation should include: A: positioning the mother in a semi-Fowler's position, administering oxygen, and providing transport. B: giving the mother 100% oxygen and attempting to manipulate the protruding limb so that delivery can occur. C: positioning the mother with her hips elevated, administering high-flow oxygen, and providing transport. D: applying gentle traction to the protruding limb to remove pressure of the fetus from the umbilical cord.
answer
C: positioning the mother with her hips elevated, administering high-flow oxygen, and providing transport. Reason: Limb presentations represent a dire emergency for the newborn and do not spontaneously deliver in the field. You should position the mother in a manner so that her hips are elevated in an attempt to slide the infant slightly back into the birth canal and remove pressure from the umbilical cord. Administer high-flow oxygen to the mother, cover the protruding limb with a sterile sheet (or any clean sheet, if a sterile sheet is not available), and transport immediately. Do NOT pull on the protruding limb as this may cause injury to the newborn.
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Medical control has ordered you to administer one tube of oral glucose to a hypoglycemic patient. Immediately after receiving this order, you should: A: administer the medication and reassess the patient. B: document the order on the prehospital care report. C: ask medical control to repeat the order word for word. D: repeat the order back to medical control word for word.
answer
D: repeat the order back to medical control word for word. Reason: Immediately after receiving an order from medical control, you should repeat the order back to medical control word for word. This will ensure that you heard correctly and understand the order to be carried out. If you receive an order that seems inappropriate, you should ask the physician to repeat the order back to you for clarification. Reassess the patient after administering the medication and document the time and patient's response (good or bad) on your patient care report.
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Which of the following interventions would the EMT be the LEAST likely to perform while attempting to resuscitate a cardiac arrest patient? A: Ventilation with a bag-mask device B: Insertion of a supraglottic airway device. C: Assisting a paramedic with intubation D: Rhythm analysis with the AED
answer
B: Insertion of a supraglottic airway device. Reason: The insertion of advanced airway devices (eg, endotracheal [ET] tube, multilumen airway, supraglottic airway) is generally outside the EMT's scope of practice. However, he or she may be asked to assist a paramedic in the placement of such devices. For example, the paramedic may ask the EMT to retrieve the appropriate equipment or preoxygenate the patient before he or she inserts the device. Operation of the AED and ventilating with a bag-mask device are within the EMT's scope of practice.
