Airway
You are treating a 22-year-old female who is experiencing a severe asthma attack. She is sitting tripod, speaking in single words, and has markedly diminished breath sounds on the left. Her SpO₂ is 88% on room air. After assisting her with her prescribed albuterol MDI, she suddenly becomes more anxious and says, “I can’t breathe,” but her breath sounds on the left side are now absent.
A. Continue assisting ventilations with a BVM and reassess
B. Administer another dose of albuterol via MDI
C. Begin immediate rapid transport and provide high-flow oxygen
D. Suspect impending respiratory failure from a pneumothorax and prepare for assisted ventilation
A suddenly silent lung after an asthma exacerbation is a red flag for impending respiratory failure or a possible tension pneumothorax developing from air trapping. The priority is to support ventilations and prepare for rapid transport. EMTs cannot decompress a chest but must recognize deterioration early.
A 67-year-old male is complaining of sudden onset crushing chest pain radiating to his left arm. He is pale, diaphoretic, and nauseated. BP 88/54, HR 54, RR 22, SpO₂ 95% on room air. He takes metoprolol and nitroglycerin for hypertension.
What is your immediate next step?
A. Assist him with his prescribed nitroglycerin
B. Place the patient supine and administer high-flow oxygen
C. Obtain a full SAMPLE history before initiating treatment
D. Prepare for immediate transport while performing supportive care en route
This patient shows classic signs of cardiogenic shock with:
Hypotension (88/54)
Bradycardia (54)
Pale, diaphoretic, nauseated
Crushing chest pain
Because his blood pressure is already low, nitroglycerin is contraindicated — it will drop his pressure further.
The best immediate action is to improve perfusion by positioning him supine and give oxygen as needed. After stabilization, he needs rapid transport, but the first priority is to correct the perfusion problem.
A 19-year-old male crashed his motorcycle at high speed. He is supine, unresponsive to pain, and breathing irregularly at 6 breaths/min. There is no obvious external bleeding. Radial pulses are absent; carotid pulses are weak and rapid. His skin is cool and pale.
What is your FIRST priority?
A. Begin bag-valve-mask ventilations with high-flow oxygen
B. Apply a cervical collar and prepare for rapid transport
C. Check blood glucose to rule out hypoglycemia
D. Perform a rapid trauma assessment to locate hidden bleeding
This patient is critically hypoventilating (6 breaths/min, irregular), which will quickly lead to hypoxia and brain injury. Airway and ventilation always come before spinal immobilization, glucose checks, or searching for hidden bleeding.
BVM with high-flow oxygen is the correct immediate intervention.
A 54-year-old female with type 1 diabetes is found confused and combative. Skin is cool and clammy. She has a medical alert bracelet and an empty insulin syringe beside her. RR 22, HR 112, BP 124/78, SpO₂ 97%. She is too combative to swallow oral glucose safely.
What should you do FIRST?
A. Administer oral glucose carefully while restraining her
B. Contact medical control for permission to administer glucagon
C. Check blood glucose level and provide high-flow oxygen
D. Immediately restrain the patient for her safety and your own
This patient shows classic hypoglycemia with altered mental status:
Cool, clammy skin
Combative/altered
Empty insulin syringe nearby
Type 1 diabetic
Because she cannot follow commands and cannot swallow safely, oral glucose is contraindicated.
As an EMT, your only medication option for hypoglycemia when oral glucose cannot be given is glucagon, and most protocols require medical control authorization.
Checking glucose is important — but when the presentation is this clear and the patient is unsafe to treat with oral glucose, contacting medical control for glucagon is the correct first action.
A 26-year-old woman at 38 weeks gestation is experiencing contractions. She tells you she feels a strong urge to push. On exam, you see crowning. The amniotic sac has not ruptured.
What should you do FIRST?
A. Carefully rupture the amniotic sac to speed delivery
B. Support the infant’s head as it delivers and be prepared to remove the sac after birth
C. Apply gentle pressure to prevent delivery until ALS arrives
D. Insert a gloved finger to sweep the sac from the infant’s face
In a normal crowning delivery with intact amniotic sac, you never intentionally rupture the sac.
Reasons:
Artificially rupturing the sac can cause uncontrolled release of fluid, increasing risk of cord prolapse or trauma.
The sac will usually rupture on its own during delivery or can be safely removed after the head delivers.
So the correct action is to:
Support the head as it delivers
When the sac is visible around the face, tear it with your fingers and clear it away after the head is out
Continue with normal delivery procedures
Dispatch sends you to a bar for a “person down.” As you approach the patient lying on the floor, several intoxicated bystanders begin yelling at you, insisting the patient “just needs to sleep it off.” They circle around you and become increasingly agitated.
What is your BEST immediate action?
A. Attempt to calm the crowd while continuing patient assessment
B. Request law enforcement and withdraw to a safe location
C. Ignore the bystanders and quickly remove the patient to the ambulance
D. Have your partner distract the crowd while you assess the patient
Scene safety is always priority #1.
Aggressive or intoxicated crowds create a volatile, unsafe environment where continuing patient care puts you and your partner at risk.
Correct actions:
Back out to a safe location
Request law enforcement immediately
Re-enter only when the scene is secure
EMTs are not expected to negotiate with a hostile group or “just push through.”
A 34-year-old male is found unresponsive after a suspected heroin overdose. He has slow, shallow respirations at 4 breaths/min and a weak pulse. His pupils are pinpoint. You have a BVM, O₂, suction, and naloxone available.
What is your first priority?
A. Administer naloxone IM or IN
B. Assist ventilations with a BVM and high-flow oxygen
C. Suction the airway to remove secretions
D. Insert an OPA and prepare for transport
With an opioid overdose, the immediate life threat is respiratory failure, not the drug itself.
The patient is breathing 4/min — profoundly inadequate. If you don’t ventilate him first, naloxone will not circulate effectively.
Correct order of care:
Open airway, ventilate with BVM + O₂
Once ventilations are effective → administer naloxone
Continue BVM until the patient can breathe adequately on their own
Suctioning and OPA placement may be needed after you start ventilations, but the very first action is BVM support.
A 72-year-old male is complaining of sudden dizziness and weakness. He is conscious but lethargic. Vitals:
BP: 78/40
HR: 32 (slow and regular)
RR: 20
Skin: cool and pale
He takes lisinopril and digoxin.
What is your MOST important immediate action?
A. Assist ventilations with a BVM
B. Place the patient supine and prepare for rapid transport
C. Administer nitroglycerin if prescribed
D. Obtain a 12-lead ECG prior to treatment
This patient is in symptomatic bradycardic shock:
HR 32
BP 78/40
Cool, pale skin
Lethargic
On digoxin, which can worsen bradycardia
The EMT priorities are:
Improve perfusion → lay him supine
Administer oxygen (as needed)
Rapid transport for ALS interventions (atropine, pacing)
Nitro is absolutely contraindicated (BP too low), and an EMT cannot delay care to obtain a 12-lead.
A 22-year-old male has a stab wound to the right upper abdomen. He is alert but in severe pain. BP 96/68, HR 124, RR 26 and shallow. His abdomen is rigid and tender. There is no external bleeding.
What should you do FIRST?
A. Apply direct pressure to the wound to control hemorrhage
B. Cover the wound with an occlusive dressing
C. Begin rapid transport while administering high-flow oxygen
D. Perform a detailed secondary assessment to identify other injuries
A stab wound to the abdomen has the potential to become an evisceration or to cause significant internal bleeding. The first step is to stabilize the wound and prevent air from entering the abdominal cavity.
An occlusive dressing is the proper immediate treatment for penetrating abdominal trauma without evisceration.
After sealing the wound:
Administer oxygen
Rapid transport is critical
Detailed assessments come second to stabilization and transport
A 19-year-old female ingested an unknown quantity of acetaminophen about 1 hour ago in a suicide attempt. She is alert, tearful, and cooperative. Vitals: BP 122/76, HR 98, RR 18, SpO₂ 99%. She has no complaints.
What is your MOST important action?
A. Contact poison control and remain on scene for recommendations
B. Administer activated charcoal if local protocol allows
C. Begin transport immediately and bring the medication bottle
D. Obtain a complete history, including SAMPLE and OPQRST, before leaving
Acetaminophen (Tylenol) overdose is extremely time-sensitive.
The patient may appear perfectly normal for hours, but severe liver failure develops later.
Because of this:
Do NOT stay on scene.
Do NOT delay for poison control.
Treatment depends on time since ingestion, and the antidote (N-acetylcysteine) works best when given early.
Activated charcoal may be allowed, but only if it does not delay transport.
The most important EMT action is:
Load and go immediately
Bring the bottle for the ED
Provide supportive care en route
A newborn is delivered after an uncomplicated labor. Immediately after birth, the baby is limp, with a weak cry and a heart rate of 84 bpm.
What should you do FIRST?
A. Begin chest compressions
B. Provide positive pressure ventilations with a BVM
C. Dry, warm, position, and stimulate the infant
D. Administer blow-by oxygen and reassess
Neonatal resuscitation follows a very strict sequence:
Initial steps: warm, dry, stimulate
If HR < 100 → begin PPV immediately
If HR < 60 after 30 sec of PPV → chest compressions
In this case:
Heart rate is 84 → <100, so the infant needs immediate positive pressure ventilation.
Stimulation alone is insufficient
Chest compressions are not indicated unless HR <60 after effective PPV
You are first on scene at a warehouse explosion with multiple victims. One man is walking around calling for help, holding his arm, which is bleeding moderately. He is alert and talking clearly.
According to START triage, how should he be categorized?
A. Immediate (Red)
B. Delayed (Yellow)
C. Minor (Green)
D. Expectant (Black)
Under START triage, anyone who is walking wounded is automatically tagged GREEN (Minor).
Even if they have injuries, the fact that they can ambulate and communicate clearly places them in the lowest-acuity group.
A 4-year-old child is in severe respiratory distress after an allergic exposure. He is sitting upright, drooling, and making a harsh inspiratory noise. His mother says it “came out of nowhere” about 20 minutes ago. He has no rash.
What should you do FIRST?
A. Assist ventilations with a BVM
B. Administer an epinephrine auto-injector
C. Provide high-flow oxygen and keep him calm
D. Lay him supine and open the airway with a jaw thrust
This presentation is classic pediatric epiglottitis, NOT anaphylaxis:
Key clues:
Sudden onset
Drooling
Sitting forward (“tripod”)
Harsh inspiratory noise (stridor)
No rash
No wheezing
High fever not always present early
In epiglottitis:
DO NOT place anything in the mouth
DO NOT agitate or lay the child down
DO NOT attempt BVM unless the child becomes apneic
Keep them upright, calm, and give gentle high-flow oxygen
Prepare for rapid transport and airway obstruction
Epinephrine is used for anaphylaxis, which this is not.
A 58-year-old woman is short of breath and complaining of “pressure” in her chest.
Vitals:
BP 142/88
HR 104, regular
RR 24, shallow
SpO₂ 93%
She takes a daily nitroglycerin but has not taken any today.
As you assist her to the ambulance, she suddenly becomes unresponsive and pulseless.
What should you do FIRST?
A. Begin chest compressions
B. Attach the AED
C. Open the airway and give two rescue breaths
D. Administer nitroglycerin immediately
When a patient becomes unresponsive and pulseless, the first step in the adult cardiac arrest algorithm is:
Start high-quality chest compressions immediately.
Why not AED first?
The AED is attached as soon as it becomes available, but compressions should begin without delay. Even a 5–10 second pause worsens outcomes.
Why not breaths first?
Adult cardiac arrest is treated with a CAB sequence (Compressions → Airway → Breathing), not ABC.
Nitro?
Absolutely contraindicated in cardiac arrest.
A 30-year-old female is involved in a high-speed MVC. She is conscious but confused. She has a large bruise over the right upper abdomen and complains of increasing abdominal pain. Her vitals:
BP 92/64
HR 128
RR 24
Skin cool and moist
What is your highest priority?
A. Obtain a detailed history and SAMPLE information
B. Administer high-flow oxygen and apply a cervical collar
C. Initiate rapid transport for suspected internal bleeding
D. Apply an occlusive dressing to the abdominal bruise
This patient shows a classic presentation of internal abdominal hemorrhage:
High-speed MVC
RUQ bruising (“seatbelt sign” or blunt trauma marker)
Hypotension (92/64)
Tachycardia (128)
Cool, moist skin
Increasing abdominal pain and confusion
There is no external bleeding to treat, and an occlusive dressing is irrelevant.
This is a load-and-go critical trauma patient.
Correct priority: Rapid transport to a trauma center while managing ABCs en route.
A 68-year-old male presents with a sudden severe headache he describes as “the worst headache of my life.” He is alert but vomiting and hypersensitive to light. BP 168/96, HR 74, RR 16. No trauma.
What is your MOST important action?
A. Administer high-flow oxygen and lay him supine
B. Transport rapidly and minimize stimulation
C. Give aspirin if permitted by local protocol
D. Check blood glucose before transport
“Worst headache of my life” with sudden onset, vomiting, photophobia, and hypertension strongly suggests a subarachnoid hemorrhage (SAH). EMT priorities:
Dim lights and minimize stimulation
Rapid transport to a stroke-capable hospital
Avoid laying the patient flat if it worsens symptoms
Aspirin is contraindicated in suspected bleeding
Glucose should be checked, but it does not precede transport in a classic high-risk neuro case
A 6-year-old boy fell off playground equipment. He is awake but crying and refusing to move his right leg. You see swelling and obvious deformity at the mid-femur. Distal pulses are present; skin is pink and warm. No bleeding.
What is your BEST immediate action?
A. Apply a traction splint
B. Stabilize with a padded board or pillow splint and transport
C. Re-position the leg to normal alignment before splinting
D. Apply ice and wait to see if the swelling decreases
For pediatric mid-shaft femur fractures:
Traction splints are generally not used in children, because open growth plates and risk of hip/knee injury make traction dangerous.
The correct stabilization is a padded board splint, vacuum splint, or pillow splint.
You do not attempt to realign unless there is no distal pulse.
Waiting to “see if it gets better” is inappropriate for a femur fracture.
You are transporting a stable patient to the hospital. Your partner is driving. As you approach an intersection with a green light, a car suddenly runs a red light from your right and is about to collide with your ambulance.
What is the BEST action?
A. Your partner should immediately brake to avoid the collision
B. Your partner should accelerate to clear the intersection
C. Maintain speed because you have the right of way
D. Turn on the siren to warn the driver in the other car
Ambulance safety rules are VERY clear on this:
➡️ The driver must avoid collisions at all costs — even if they have the right of way.
A vehicle running a red light creates an immediate hazard. The safest move is:
Brake immediately.
Speeding up risks a direct T-bone collision
“Having the right of way” is irrelevant in emergency vehicle safety
A siren will not help in time to prevent a crash
You are treating a 52-year-old man complaining of sudden sharp chest pain and shortness of breath after coughing forcefully. He is tall and thin and has a history of smoking.
Vitals:
BP 132/84
HR 118
RR 26
SpO₂ 92%
Breath sounds are clear on the right and absent on the left. No trauma is noted.
What is your MOST likely working diagnosis?
A. Pulmonary embolism
B. Acute asthma exacerbation
C. Spontaneous pneumothorax
D. Pleuritic chest pain from coughing
This patient has classic spontaneous pneumothorax indicators:
Sudden sharp chest pain
Tall, thin male (high-risk demographic)
Absent breath sounds on one side
No trauma
Recent coughing episode
Tachycardia + mild hypoxia
Asthma would produce wheezing.
PE would show clear breath sounds bilaterally.
Pleuritic pain wouldn't cause unilateral absent breath sounds.
A 63-year-old woman is complaining of chest discomfort and lightheadedness. She is pale and anxious.
Vitals:
BP 90/60
HR 160, regular
RR 24
SpO₂ 95%
She denies taking any medications today. She says the symptoms began suddenly while resting.
What is the MOST likely cause of her condition?
A. Ventricular tachycardia
B. Supraventricular tachycardia
C. Hypovolemic shock
D. Acute myocardial infarction
This patient has:
HR ~160, regular
Sudden onset while resting
Lightheadedness + borderline hypotension (90/60)
Pale/anxious
No chest pain typical of MI
Stable enough to speak but symptomatic
A heart rate this high and regular most strongly suggests SVT.
Why not the others?
Ventricular tachycardia (A):
Usually presents with HR 160–200 but often wide-complex and unstable, often unconscious or nearly so. Too sick for this presentation.
Hypovolemic shock (C):
Would have tachycardia, but there’s no bleeding, vomiting, sepsis, sweating, or history indicating volume loss — and the HR jump was sudden at rest.
Acute MI (D):
HR in MI is rarely 160 sustained and regular.
MI pain is usually severe and consistent, not just “discomfort” with sudden onset at rest.
A 17-year-old skateboarder fell and struck his head. He was witnessed losing consciousness for ~20 seconds. Now he is awake but confused, repeatedly asking the same questions. His vitals:
BP 132/78
HR 68
RR 18
Pupils equal and reactive
No external bleeding
What is the MOST appropriate immediate action?
A. Immobilize the c-spine and transport for evaluation
B. Administer high-flow oxygen and perform a detailed neurological exam
C. Assist ventilations because he lost consciousness
D. Check blood glucose before treating further
This patient is showing classic symptoms of a concussion with persistent confusion and repetitive questioning (“retrograde amnesia”). Even though vitals are normal and pupils are equal, the loss of consciousness + mental status change requires:
Immediate c-spine precautions
Expedited transport for CT and neuro evaluation
Avoid delays on scene
Checking glucose is appropriate later, but not before immobilization and transport.
Detailed exams should not delay movement.
A 62-year-old woman with a history of COPD and diabetes presents with fever, productive cough, and increasing shortness of breath. She is confused and slow to respond.
Vitals:
BP 88/54
HR 124
RR 32
SpO₂ 91% on room air
Temp 103.1°F
What is your MOST important action?
A. Administer high-flow oxygen and assist ventilations if needed
B. Give the patient aspirin according to cardiac protocol
C. Obtain a blood glucose level before treating
D. Provide oral fluids to prevent dehydration
This patient meets criteria for septic shock:
Hypotension (88/54)
Tachycardia (124)
Tachypnea (32)
Fever (103.1°F)
Altered mental status
Likely pneumonia source
The immediate life threats are hypoxia and respiratory failure.
As an EMT, your priorities are:
Administer high-flow oxygen
Assist ventilations as needed
Rapid transport to a hospital capable of sepsis care
Aspirin is only for suspected MI.
Oral fluids are contraindicated in altered patients.
Glucose check is appropriate but not before airway/breathing interventions.
A 3-year-old girl is found unresponsive in her crib. Her skin is cool and pale. She has slow, shallow respirations at 8/min and a weak carotid pulse at 70 bpm.
What is your IMMEDIATE intervention?
A. Begin chest compressions
B. Provide positive pressure ventilations with a BVM
C. Administer high-flow oxygen via NRB
D. Insert an OPA and reassess
A 3-year-old with:
RR 8/min (critically low)
Weak pulse
Unresponsive
Pale, cool skin
…is in respiratory failure, and without intervention will soon progress to cardiac arrest.
In pediatrics:
Ventilation failure is the #1 cause of pediatric cardiac arrest.
Correct immediate action:
Provide positive pressure ventilations with a BVM
Then reassess the heart rate after 30 seconds:
If HR < 60 despite adequate ventilations → start chest compressions
Oxygen alone is insufficient, and an OPA is appropriate after you establish ventilations.
You are responding to a mass-casualty incident involving a bus crash. You are the first EMS unit on scene. Multiple patients are walking around, some lying on the ground, and traffic is still moving nearby.
What is your FIRST action?
A. Begin START triage immediately
B. Request additional resources and establish command
C. Move walking wounded to a treatment area
D. Begin treatment of the most critical patient
At a mass-casualty incident, the very first action for the first arriving EMS unit is:
✔️ Establish command and request additional resources
This comes before triage, treatment, or moving patients.
Why?
You need more units
You must control scene organization
Safety and structure are the priority
EMS cannot function without ICS in place
START triage (A) begins after command is established.
Treating patients first (D) is incorrect in MCI management — you triage first.
You find a 71-year-old man slumped in a recliner. He responds only to painful stimuli. His breathing is slow and shallow at 8/min. His SpO₂ is 86% on room air. You hear snoring respirations.
What should you do FIRST?
A. Insert an OPA and begin BVM ventilations
B. Apply high-flow oxygen via nonrebreather
C. Perform a jaw-thrust maneuver and reassess breathing
D. Check blood glucose before airway interventions
This patient is:
Unresponsive to all but pain
Snoring (→ airway partially blocked)
RR 8/min (inadequate)
SpO₂ 86%
Shallow respirations
This is airway obstruction + respiratory failure.
Correct sequence:
Open airway + insert OPA (he’s not responsive enough to resist)
Begin BVM ventilations with high-flow O₂
A NRB mask (choice B) is not enough — he cannot ventilate on his own.
Jaw thrust (C) is good, but not enough alone for someone breathing 8/min.
Glucose check (D) is never before airway.
You respond to a 67-year-old man with a sudden onset of crushing chest pain and shortness of breath. He is pale, mildly confused, and sweating heavily.
Vitals:
BP: 84/52
HR: 42 and regular
RR: 22
SpO₂: 93%
He takes metoprolol and aspirin daily. He has his prescribed nitroglycerin with him.
What is your PRIORITY action?
A. Assist him with his prescribed nitroglycerin
B. Administer high-flow oxygen and prepare for immediate transport
C. Place him sitting upright to relieve breathing difficulty
D. Begin CPR because his heart rate is dangerously low
This patient is showing signs of cardiogenic shock due to an inferior MI with bradycardia:
BP 84/52 (hypotension)
HR 42 (significant bradycardia)
Pale, sweaty, confused (poor perfusion)
On metoprolol → can worsen bradycardia
Chest pain + shock = critical MI
A 22-year-old male was stabbed in the left side of the chest. He is awake but anxious.
Vitals:
BP 98/72
HR 132
RR 28 and shallow
SpO₂ 90%
Breath sounds are diminished on the left, and you see a small open wound bubbling with each breath.
What is your IMMEDIATE action?
A. Seal the wound with an occlusive dressing
B. Begin rapid transport and reassess en route
C. Assist ventilations with a BVM
D. Lay the patient flat and cover the wound with gauze
This patient has an open pneumothorax (sucking chest wound). Key findings:
Bubbling wound
Diminished breath sounds on the affected side
Respiratory distress (RR 28, shallow)
Tachycardia and borderline hypotension
Your immediate action is to:
Seal the wound with an occlusive dressing (usually taped on 3 sides)
This prevents further air from entering the chest cavity and worsening the pneumothorax.
Then:
Administer oxygen
Monitor for tension pneumothorax
Rapid transport
A 40-year-old male with a history of COPD is in moderate respiratory distress. You hear diminished breath sounds with faint wheezing. He is alert but speaking only in short sentences.
Vitals:
BP 148/90
HR 128
RR 32
SpO₂ 89% on room air
He has his prescribed albuterol MDI but says he used it 30 minutes ago with no improvement.
What is your BEST immediate action?
A. Assist ventilations with a BVM
B. Administer another dose of albuterol
C. Provide high-flow oxygen and prepare for rapid transport
D. Place the patient in the supine position to improve perfusion
This patient is showing signs of severe COPD exacerbation with worsening respiratory distress:
RR 32
HR 128 (compensating)
SpO₂ 89%
Speaking only in short sentences
Already used his albuterol 30 minutes ago with no improvement
That tells you:
Bronchodilator failure — the obstruction is not responding to albuterol.
The patient is at risk of respiratory fatigue and failure.
What should EMTs do?
Oxygen immediately
Position upright
Rapid transport for advanced airway/medications
Assist ventilations if he deteriorates
Giving more albuterol after a failed dose is not the priority.
A 32-year-old woman at 36 weeks gestation reports sudden, sharp abdominal pain followed by heavy vaginal bleeding. She is pale, anxious, and short of breath. She denies trauma.
Her abdomen feels rigid on palpation, and the fetus is difficult to palpate.
Vitals:
BP: 88/56
HR: 128
RR: 26
Skin: cool, clammy
What is the MOST likely cause of her condition?
A. Placenta previa
B. Abruptio placentae
C. Braxton-Hicks contraction with spotting
D. Uterine rupture
Both abruptio placentae and uterine rupture can present with abdominal pain and bleeding — but the key details here point strongly to uterine rupture:
Clues indicating uterine rupture:
Sudden, severe abdominal pain
Heavy vaginal bleeding
Rigid abdomen
Fetus difficult to palpate (classic sign — fetus may shift outside uterus)
Hypotension + tachycardia (shock)
Decompensating mother = decompensating fetal status
This is a true obstetric emergency with extremely high maternal/fetal mortality.
Why not abruptio placentae?
Abruption causes painful bleeding, but the fundus and fetus remain intact. The abdomen is usually tender, not rigid, and fetal parts are still easy to palpate.
Why not placenta previa?
Previa → painless bleeding.
Why not Braxton-Hicks?
Not associated with hemorrhage or shock.
You and your partner are transporting a stable patient to the hospital in moderate traffic. You are running lights and sirens. As you approach an intersection with a red light, cross-traffic is moving at full speed. Your partner asks, “Should I proceed through?”
What is the BEST response?
A. “Yes, go through quickly so we don’t get stuck.”
B. “Turn off the siren so traffic can hear us better.”
C. “Slow down and stop until all vehicles yield to us.”
D. “Accelerate to clear the intersection before traffic reaches us.”
Even with lights and sirens, emergency vehicles must follow this rule:
STOP at a red light and proceed ONLY when all cross-traffic has yielded.
You NEVER “blast through” a red light.
Accidents at intersections are the #1 cause of ambulance crashes.
A & D are dangerous and violate EVOC rules.
B turning off your siren makes you less visible/audible.
A 4-year-old boy has swallowed a coin and is coughing forcefully. He is alert, crying, and can speak a few words between coughs.
What is the BEST action?
A. Begin abdominal thrusts immediately
B. Encourage him to cough and keep him upright
C. Deliver 5 back blows followed by 5 chest thrusts
D. Insert a laryngoscope to visualize the airway
This child has a partial airway obstruction:
Forceful coughing
Able to cry
Able to speak a few words
Alert and maintaining posture
For partial obstructions, the correct action is:
Encourage coughing and keep the child upright.
Do NOT perform abdominal thrusts or back blows unless:
The child cannot cough
Cannot speak
Cannot breathe effectively
Becomes unresponsive
And obviously, EMTs do not use laryngoscopes.
A 73-year-old man is complaining of “pressure” in his chest and shortness of breath. While you’re assessing him, he suddenly becomes unresponsive. He has agonal respirations and no carotid pulse.
Your AED is immediately available.
What should you do FIRST?
A. Deliver two rescue breaths, then apply the AED
B. Begin chest compressions immediately
C. Apply the AED pads and analyze before compressions
D. Check for a radial pulse to confirm cardiac arrest
When a patient is:
Unresponsive
Has agonal respirations
No carotid pulse
…this is cardiac arrest.
The adult cardiac arrest sequence is:
Start chest compressions immediately
Apply the AED as soon as possible
Follow prompts
You arrive at the scene of a woodworking accident. A 45-year-old male has a deep laceration to his forearm with heavy, spurting bleeding. He is pale and anxious. You apply direct pressure, but the bleeding continues.
What is your NEXT step?
A. Apply a pressure dressing and elevate the limb
B. Apply a tourniquet proximal to the wound
C. Insert wound packing with hemostatic gauze
D. Apply an occlusive dressing to seal the wound
The patient has arterial bleeding (spurting, heavy), and direct pressure has failed.
According to current trauma and Stop the Bleed guidelines:
Next step is an immediate tourniquet, placed high and tight or 2–3 inches proximal to the wound.
Why not the others?
Pressure dressing/elevation: Too slow for uncontrolled arterial hemorrhage.
Hemostatic gauze: Used for junctional or cavity wounds when a tourniquet cannot be applied.
Occlusive dressing: For chest or neck wounds — not for extremity bleeds.
Firefighters pull a 29-year-old male from a house fire. He is awake but coughing heavily and has soot around his mouth. His voice is hoarse and he is drooling slightly.
Vitals: BP 132/84, HR 118, RR 28, SpO₂ 97% on room air.
What is your MOST important immediate action?
A. Apply high-flow oxygen via nonrebreather
B. Administer nebulized albuterol
C. Begin rapid transport for suspected airway burns
D. Suction the airway aggressively to remove soot and secretions
This patient has multiple red flags for impending airway compromise due to inhalation burns:
Hoarse voice
Soot around the mouth
Drooling
Coughing heavily
Tachycardia and tachypnea after fire exposure
SpO₂ = 97% does NOT rule out inhalation injury—carboxyhemoglobin can falsely elevate readings.
The priority is:
Rapid transport to a burn center / advanced airway-capable hospital
Continue to provide:
High-flow oxygen
Gentle airway management
Prepare for deterioration
Aggressive suctioning can worsen swelling. Albuterol is not indicated.
A newborn is delivered but is not crying.
Assessment:
Weak respirations at 12/min
Heart rate 78 bpm
Limp tone
No cyanosis
Umbilical cord already clamped
What is your FIRST priority?
A. Begin chest compressions
B. Provide positive-pressure ventilations (PPV)
C. Dry, warm, and stimulate the infant
D. Administer blow-by oxygen
Neonatal resuscitation follows a strict algorithm.
This newborn has:
RR 12/min (inadequate — normal is 40–60/min)
Heart rate 78 bpm (<100)
Limp tone
Not crying
Per NRP/NREMT standards:
HR <100 → Immediate PPV (positive-pressure ventilation)
Drying/warming/stimulating comes before HR assessment, but in this question, we are already past that stage because we have full vital signs.
Chest compressions are only for HR <60 after 30 seconds of effective PPV.
Blow-by oxygen is not enough for an apneic/hypoventilating newborn.
You and your partner are lifting a 250-lb patient on a stretcher down three porch steps. As you descend the second step, your partner suddenly says, “Stop — my grip is slipping!”
What is the BEST action?
A. Continue lifting to avoid dropping the patient
B. Immediately lower the stretcher to the ground in a controlled manner
C. Shift the weight toward yourself until your partner regains grip
D. Tell your partner to readjust quickly while you continue holding the load
When anyone on your crew loses grip or announces they cannot safely hold weight:
You immediately lower the stretcher to the ground in a controlled manner.
This prevents:
Dropping the patient
Injuries to you or your partner
Losing control on stairs
You never:
Keep going (A)
Shift weight to one person (C)
Tell your partner to hurry up while holding the load (D)
Lowering the cot is ALWAYS the correct safety action.
A 22-year-old woman has severe respiratory distress after being stung by a bee. She is wheezing loudly, struggling to speak, and her SpO₂ is 88%. She has an epinephrine auto-injector. She is alert but getting more exhausted.
What is your IMMEDIATE action?
A. Administer her epinephrine auto-injector
B. Assist ventilations with a BVM
C. Administer high-flow oxygen via NRB
D. Lay her supine and elevate her legs
This patient is in severe anaphylaxis, evidenced by:
Wheezing
Struggling to speak
SpO₂ 88%
Rapid exhaustion
For a conscious patient who is still breathing — even if working VERY hard — the first and most important intervention is:
Immediate epinephrine
Why?
Epinephrine reverses airway edema, bronchoconstriction, and shock
It treats the underlying problem
BVM is for impending respiratory arrest — she’s struggling, but still moving air
NRB oxygen (C) is helpful after epi
Supine position (D) can worsen breathing difficulty
You arrive on scene for a 58-year-old male with chest discomfort. As you begin your assessment, he suddenly becomes unresponsive. He is NOT breathing. You do a quick carotid pulse check and feel a weak, slow pulse at 38 bpm.
What should you do NEXT?
A. Begin chest compressions
B. Provide positive-pressure ventilations with high-flow oxygen
C. Apply the AED and analyze rhythm
D. Administer the patient’s prescribed nitroglycerin
The patient is unresponsive and NOT breathing, but has a pulse (weak, 38 bpm).
This is respiratory arrest with a pulse, NOT cardiac arrest.
In adults:
If there is no breathing but a pulse, you must begin ventilations, not compressions.
Deliver:
1 ventilation every 5–6 seconds (10–12/min)
With high-flow oxygen
Recheck pulse every 2 minutes
ou arrive on scene for a 24-year-old male who was stabbed in the lower left abdomen during an assault. He is lying supine, pale, and very anxious.
Findings:
There is a 3-inch stab wound with loops of bowel protruding
He is guarding the area and trying to push your hands away
BP: 92/68
HR: 132
RR: 28 and shallow
Skin: cool and clammy
No other injuries found
What is your BEST immediate action?
A. Apply direct pressure to the wound to control bleeding
B. Gently cover the exposed organs with sterile, moistened dressings
C. Attempt to push the intestines back into the abdominal cavity
D. Apply an occlusive dressing taped on all four sides to seal the wound
This is a penetrating abdominal trauma with evisceration.
Your priorities are:
Protect the exposed organs
Prevent further contamination and heat loss
Avoid causing internal damage
B. Gently cover the exposed organs with sterile, moistened dressings
This is the ONLY correct action for eviscerations.
Why not the others?
A. Direct pressure
Never apply direct pressure to exposed organs — can crush or rupture them.
C. Push organs back inside
Absolutely contraindicated — can tear mesentery, cause infection, or perforate bowel.
D. Occlusive dressing
Used for open chest wounds, NOT abdominal eviscerations.
A 28-year-old male with type 1 diabetes is found unconscious at home. His roommate states he has been vomiting all day and “didn’t take his insulin because he wasn’t eating.”
He is breathing rapidly and deeply.
Vitals: BP 104/70, HR 128, RR 32, skin warm and dry, breath smells fruity.
What condition do you MOST suspect?
A. Hypoglycemia
B. Diabetic ketoacidosis (DKA)
C. Hyperosmolar hyperglycemic crisis
D. Insulin overdose
This is a textbook presentation of diabetic ketoacidosis (DKA):
Key clues:
Type 1 diabetic
Vomiting → dehydration
Didn’t take insulin → glucose skyrockets
Rapid, deep respirations (Kussmaul)
Warm, dry skin
Fruity/acetone breath
Tachycardia
DKA patients are often acidotic but not hypoxic, so they breathe deeply to blow off CO₂.
Not hypoglycemia — that would cause cool/clammy skin and AMS, not Kussmaul breathing.
Not HHS — that occurs mostly in type 2 diabetics and presents without Kussmaul respirations.
A 5-year-old child is found unresponsive in bed. He is breathing at 10/min, shallow. You palpate a carotid pulse of 52 bpm. Skin is pale and cool. No trauma.
What should you do FIRST?
A. Begin chest compressions
B. Provide 15:2 CPR with a single rescuer
C. Provide positive-pressure ventilations with a BVM
D. Administer blow-by oxygen and reassess
This child is in respiratory failure, which is the #1 cause of pediatric cardiac arrest.
Findings:
RR 10/min (too slow for a 5-year-old)
Breathing shallow
Carotid pulse 52 bpm
Unresponsive
Pale, cool skin (poor perfusion)
In pediatric patients:
If the child is unresponsive, breathing is inadequate, and the pulse is <60, you must begin positive-pressure ventilations FIRST.
After 30 seconds of effective PPV:
If HR stays <60 → begin chest compressions (BLS CPR).
You are transporting a 64-year-old cardiac patient who initially had crushing chest pain but was alert during your assessment. Five minutes into transport, while your partner is driving with lights and sirens, the patient suddenly becomes unresponsive.
You check:
No pulse
No breathing
The monitor shows V-fib
You are on a busy highway traveling 55 mph.
What should your partner do NEXT?
A. Continue driving emergently while you begin CPR in the patient compartment
B. Slow down but continue driving while you attach the AED
C. Pull over safely and stop the ambulance so you can begin CPR immediately
D. Skip CPR and deliver a defibrillation while the ambulance remains in motion
This is one of the most important EMS Operations rules:
If a patient arrests during transport, the driver MUST pull over safely and stop the ambulance before CPR is started.
Why?
CPR in a moving ambulance is ineffective.
Studies show chest compression quality drops severely when the vehicle is moving.
It is extremely unsafe for the provider performing CPR (high risk of injury/fall).
Defibrillation must NEVER be performed in a moving vehicle.
Electricity + motion = risk to crew.
Stopping the ambulance allows:
High-quality CPR
AED analysis
A safer work environment
Crew coordination
A 19-year-old male was pulled from a lake after a near-drowning incident. He is now awake but confused. He is breathing rapidly at 32/min with crackles in both lungs. SpO₂ is 85% on room air. He is coughing up pink, frothy sputum.
What is your BEST initial action?
A. Assist ventilations with a BVM
B. Administer high-flow oxygen and prepare for deterioration
C. Suction aggressively to remove frothy sputum
D. Apply CPAP immediately
Explanation
This patient has near-drowning with pulmonary edema:
Pink, frothy sputum
Crackles
Tachypnea
Low SpO₂ (85%)
Awake but confused
Best action:
High-flow oxygen
Monitor closely
Prepare for BVM if he tires.
A 72-year-old woman complains of dizziness and fatigue. She suddenly becomes unresponsive. You check and find a pulse of 30 bpm, weak, and thready. She is NOT breathing.
What should you do FIRST?
A. Begin CPR
B. Attach the AED
C. Provide positive-pressure ventilations
D. Administer high-flow oxygen via NRB
This patient is in respiratory arrest with a pulse:
Pulse 30
Not breathing
Unresponsive
For adults:
Pulse but no breathing = PPV (1 breath every 5–6 sec)
NOT CPR unless pulse <10 or disappears.
A 28-year-old male was hit in the chest with a baseball bat during a fight. He is awake but slowing down mentally. His chest wall is soft on the left side, and you note paradoxical movement during breathing. His breathing is labored at 34/min.
What is your PRIORITY treatment?
A. Stabilize the flail segment with bulky dressings and assist ventilations
B. Apply a nonrebreather mask with high-flow oxygen
C. Rapid transport without interventions
D. Lay him flat to improve perfusion
Signs:
Paradoxical movement
Increasing respiratory distress (RR 34)
Altered mentation
Soft chest wall segment
This is a flail chest.
Treatment priorities:
Stabilize flail segment (bulky dressing or manual support)
Assist ventilations
Rapid transport
A 52-year-old diabetic male with a history of alcohol abuse is confused, sweaty, and slurring his speech. He is combative when touched. His skin is cool and pale.
You attempt to give oral glucose, but he cannot follow instructions and keeps pushing it away.
What should you do NEXT?
A. Force the glucose between his cheek and gums
B. Prepare to assist ventilations and transport immediately
C. Contact medical control for glucagon authorization
D. Wait until he calms down and try glucose again
Patient is:
Altered
Cool + pale
Diabetic
Can’t follow commands
Combative
Can't take oral glucose safely
You cannot give oral glucose.
Correct EMT action:
Call medical control for glucagon authorization
Prepare for airway issues
Transport rapidly
A 3-week-old infant is breathing at 8/min, shallow. He is limp, pale, and unresponsive. You palpate a brachial pulse of 76 bpm.
What should you do FIRST?
A. Begin chest compressions
B. Provide positive-pressure ventilations
C. Begin 15:2 CPR
D. Suction the airway
A 3-week-old with:
RR 8/min (dangerously low)
Limp, pale, unresponsive
Pulse 76
For infants:
If breathing is inadequate → immediate PPV
Recheck heart rate after 30 seconds
If HR < 60 → start CPR
You and your partner are transporting a trauma patient emergently when dispatch notifies you that a second critical call has come in just two blocks from your current location. You are the closest unit, and dispatch asks, “Can you divert?”
Your current patient is stable, immobilized, and en route to the trauma center with lights and sirens. You are currently 5 minutes from the hospital.
What is the MOST appropriate response?
A. Divert to the new call, since you are closest and the current patient is stable
B. Ask dispatch for more details about the new call before deciding
C. Continue transporting your current patient and advise dispatch to send another unit
D. Stop the ambulance, reassess your current patient, and then choose the best option
Your current patient is:
Already packaged
Already being transported emergently
En route to a trauma center
Only 5 minutes away
Even if the patient is currently stable, once transport begins:
EMS must complete the transport
unless reassigned by command for a mass-casualty or disaster-level situation.
Key principles:
You cannot abandon a patient already in your care
Dispatch cannot force you to divert if doing so compromises care
Another unit can be sent to the new call
You are already committed to a higher level of care (trauma center)