Head Injuries
This type of injury often results from rapid acceleration and deceleration and causes the brain to hit the inside of the skull in multiple areas.
Coup-Contrecoup
You hear gurgling while assessing a semi-conscious trauma patient. What do you do first?
Check the airway, and suction if necessary
A 62 year old male has chest pain radiating to the left arm and is diaphoretic. What can you suspect?
You arrive at a multiple casualty incident and must quickly sort patients. This is called?
START
You arrive on scene of a high-speed T-bone collision. A 35-year-old male is found unresponsive in the driver's seat. He has obvious head trauma, snoring respirations, a deformed femur, and a weak radial pulse. His GCS is 6.
What is your immediate priority, and how do you proceed with treatment and transport?
A. Apply cervical collar and splint femur before transport
B. Perform jaw-thrust, apply OPA, begin BVM, rapid extrication, and transport
C. Administer oxygen via NRB and reassess GCS in 5 minutes
D. Wait for ALS to arrive before moving the patient
Answer: B - ABCs take priority. The airway must be opened immediately, and BVM with OPA is indicated. Rapid extrication is warranted due to altered mental status.
Anterior Fontanelles
A child with asthma is having trouble speaking, has nasal flaring, and intercostal retractions. What is the patient experiencing?
Your patient has a sudden onset of slurred speech, facial droop, and arm weakness. What do you suspect?
Stroke or CVA
A Patient is not breathing, even after you open the airway. What triage tag do they get under START?
Black
A 50-year-old male was burned when a chemical exploded in his garage. He has partial and full-thickness burns on his chest, arms, and face. He is coughing and has soot around his nose and mouth.
What are your main concerns, and how should this patient be managed?
A. Begin cooling the burns with water and wrap in dry dressings
B. Administer high-flow oxygen, protect the airway, and prepare for early transport
C. Decontaminate with sterile saline and transport to burn unit
D. Apply wet dressings and assess for other injuries
Answer: B – This is a critical burn with likely airway involvement. Early airway protection and rapid transport are essential.
You respond to a motor vehicle crash involving a 45 year old female. She is unconscious with irregular respirations, a slow heart rate, and a widening pulse pressure. What is she exhibiting?
A 52 year old man is cyanotic with snoring respirations and no gag reflex, how do you open and maintain the airway?
Insert an OPA and begin ventilating with a BVM.
You arrive to find a 58-year-old male pulseless and apneic. CPR has been in progress for 3 minutes. AED advises “No Shock.”
What’s your next move?
A. Continue CPR, reassess every 2 minutes, transport when ready
B. Wait for shockable rhythm to appear
C. Immediately begin transport
D. Check for pulse manually
Answer: A – Continue high-quality CPR. AED only shocks shockable rhythms. Reassess every 2 minutes.
You arrive at a chemical spill with patients coughing and tearing up. Where do you stage and what is your next step?
Uphill and upwind and call HazMat
A 4-year-old is found sitting upright, drooling, and struggling to breathe with stridor. Parents say symptoms started rapidly after a fever this morning.
What condition do you suspect, and what is the best initial management?
A. Asthma; administer albuterol via nebulizer
B. Croup; provide humidified oxygen and transport
C. Epiglottitis; avoid airway manipulation, provide blow-by O2, transport rapidly
D. Foreign body aspiration; perform abdominal thrusts
Answer: C – Sudden onset with fever, drooling, stridor, and tripod position suggests epiglottitis. Do not agitate or try to visualize the airway.
An intoxicated patient has a head injury and is vomiting with an ALOC. What should you do first? a. Call PD b. Assume it's ETOH and let them sleep c. Suction airway and treat as head trauma D. Give the patient oral glucose
C. Suction the Airway and treat the patient as a head trauma
A COPD Patient is in respiratory distress, breathing with pursed lips and has barrel chest. What can do do first?
Assist with their prescribed bronchodilator.
A 60-year-old male has facial droop, slurred speech, and cannot raise his right arm. Symptoms began 20 minutes ago. BP is 198/110.
What’s your transport decision?
A. Treat on scene until BP lowers
B. Administer aspirin and transport non-emergent
C. Notify stroke center and transport rapidly
D. Wait to confirm with blood glucose and ECG
Answer: C – Suspected stroke within time window: rapid transport to stroke center is priority. No aspirin given for suspected stroke.
Who has overall command responsibility at an MCI and what are the ICS branches?
IC
Logistics, Planning, Operations, Finance
A 68-year-old woman presents with slurred speech and right-sided weakness. Her daughter says she's diabetic and hasn’t eaten today. GCS is 13.
What’s your differential and immediate step?
A. Assume stroke and begin rapid transport to stroke center
B. Perform blood glucose check before deciding next steps
C. Administer oral glucose and recheck vitals
D. Load and go, checking glucose en route
Answer: B – Stroke and hypoglycemia can present similarly. A glucose check is quick and essential.
A 32 year old female was assaulted and hit on the side of her head. She is now unconscious. You note bruising behind her left ear and clear fluid draining from her nose. What do you suspect?
Basilar skull fracture - indicated by Battle Sign's and Possible CSF
A 74-year-old male with a history of COPD complains of difficulty breathing. He is using accessory muscles, has crackles in both lungs, is coughing frothy sputum, and is on home oxygen.
What is your working diagnosis and initial management?
A. Acute COPD exacerbation; assist ventilations with BVM
B. CHF; sit the patient upright, administer CPAP, and high-flow O2
C. CHF; lay the patient flat, give low-flow oxygen, and monitor
D. COPD; administer bronchodilator and transport in Trendelenburg position
Answer: B – Frothy sputum and crackles suggest pulmonary edema. CPAP helps push fluid out of the alveoli.
A 19-year-old male collapses while playing basketball. Witnesses say he shook briefly, then was unresponsive for 1 minute. He is now awake but confused.
What is the likely cause, and how should you proceed?
A. Cardiac event; apply AED and transport
B. Heat stroke; cool and monitor
C. Seizure; reassure, check glucose, and transport for eval
D. Drug overdose; administer naloxone
Answer: C – Postictal confusion after brief seizure-like activity suggests seizure. Glucose check is essential.
You arrive at a warehouse with two unconscious patients and a strong chemical odor. Bystanders are coughing.
What should you do first?
A. Enter and remove victims to safety
B. Put on gloves and assess patients in the building
C. Call for HazMat, establish safe zone, and prevent exposure
D. Apply oxygen to patients inside the building
Answer: C – Never enter a HazMat scene without appropriate PPE. Secure the scene, isolate, and deny entry.
A 30-year-old male is pacing, shouting, and appears paranoid. Bystanders say he’s schizophrenic and hasn’t taken meds in a week.
What is your top priority when managing this patient?
A. Try to physically restrain the patient and administer sedatives
B. Speak calmly, establish rapport, and request law enforcement backup
C. Approach quickly to gain control
D. Leave the scene immediately and call for psych team
Answer: B – Scene safety and de-escalation are key. EMS should not restrain unless necessary, and police assistance is appropriate.