Scene-Size Up and Safety
The scene of a multiple-car accident has been deemed safe. After standard precautions, which of the following is the most appropriate next step?
A. Correct any life-threatening conditions
B. Assess each patient's level of consciousness
C. Determine the number of patients
D. Request additional resources
Correct answer: Determine the number of patients
The scene size-up is the first step of any incident. It involves ensuring scene safety, determining the mechanism of injury/nature of the illness, taking standard precautions, determining the number of patients, and considering/requesting additional or specialized resources. All of these steps are completed prior to the assessment of or interventions on patients.
Requesting additional resources is only helpful if the total number of patients is known.
Which chamber of the heart is responsible for sending deoxygenated blood to the lungs for reoxygenation?
A. Left ventricle
B. Right Ventricle
C. Left Atrium
D. Right Atrium
Correct answer: Right ventricle
The right ventricle pumps deoxygenated blood to the lungs, to be oxygenated, via the pulmonary artery. Oxygenated blood returns to the left atrium via the pulmonary vein. Oxygenated blood flows from the left atrium to the left ventricle through the mitral valve. The left ventricle pumps the blood to the body via the aorta. Deoxygenated blood returns from the body to the right atrium via the superior and inferior vena cavae. Deoxygenated blood flows from the right atrium to the right ventricle through the tricuspid valve.
A 65-year-old female fell and hurt her ankle. The ankle has an obvious deformity. After splinting the ankle, which of the following is appropriate to assess?
A. Pulse, proximal to the injury.
B. Cardiovascular and neurological function of the affected limb.
C. Cardiovascular and neurological function of all limbs.
D. Sensation, proximal to the injury.
Correct answer: Cardiovascular and neurological function of the affected limb
Any extremity that requires splinting (e.g., due to being painful, swollen, or deformed) requires an assessment of cardiovascular and neurological function before and after the application of a splint. This is accomplished via distal pulses and motor and sensory function, respectively.
A seven-year-old male is suspected to have a mild airway obstruction with good air exchange. Which of the following actions is the most appropriate at this time?
A. Attempt to remove the obstruction manually.
B. Administer abdominal thrust.
C. Open the airway and ventilate the child.
D. Provide oxygen, place the child in a position of comfort, and transport rapidly.
Correct answer: Provide oxygen, place the child in a position of comfort, and transport rapidly
If a mild/ partial airway obstruction exists—typically indicated by a patient being able to talk and breathe—it is appropriate to provide supplemental oxygen, place the patient in a position of comfort or in the caregiver's lap, and transport.
Avoid interventions that may further obstruct the airway (e.g., ventilation that may force the object farther into the airway). Attempts to remove the obstruction manually may also force the object farther into the airway. Abdominal thrusts are not effective for dislodging a partial obstruction.
What is the purpose of opening and closing the oxygen tank prior to attaching the regulator?
A. To ensure the valve is working properly
B. To remove dirt or contaminants from the opening
C. To check the pressure inside the tank
D. To ensure the tank is filled.
Correct answer: To remove dirt or contaminants from the opening
An oxygen cylinder is "cracked" before attaching the regulator to remove dirt and other particles. The tank key (wrench) is used to rotate the valve counterclockwise to open the tank and then clockwise to close the tank. " Cracking" the tank proves that the valve is working properly, but functionality is not the primary reason for cracking a tank.
The pressure regulator, which is attached after cracking a tank, is used to determine whether the tank is full or find the remaining pressure within the tank.
Which of the following patients is most likely to present with angina pectoris?
A. A tall, thin, 21-year-old male with sudden-onset dyspnea and unequal breath sounds.
B. A 70-year-old male with a history of osteoporosis and diabetes without current symptoms.
C. A 32-year-old female who is wheezing and has an extensive hay fever history.
D. A 38-year-old overweight male with chest heaviness and a history of hypertension.
Correct answer: A 38-year-old overweight male with chest heaviness and a history of hypertension
Angina pectoris is temporary chest pain that occurs when the heart’s need for oxygen exceeds its supply. It can involve chest pain/discomfort that is typically described as pressure or heaviness, nausea/vomiting, and sweating. Pain associated with angina pectoris is commonly alleviated with rest and rarely lasts longer than 15 minutes; nitroglycerin is also a treatment option.
A tall, thin male with sudden-onset dyspnea and unequal breath sounds is likely suffering from spontaneous pneumothorax.
A wheezing female likely has allergic rhinitis (hay fever) secondary to airborne allergens.
A man without symptoms does not appear to have any current issues.
A patient is experiencing hypovolemic shock due to uncontrolled hemorrhaging. Which of the following signs or symptoms is not expected?
A. Clammy skin
B. Bradycardia
C. Tachypnea
D. Confusion
Correct answer: Bradycardia
Hypovolemic shock is inadequate fluid/volume in the circulatory system. Common causes of hypovolemic shock are bleeding ( hemorrhagic shock) and dehydration, such as from inadequate fluid intake, diarrhea, and/or vomiting. Patients will typically present with the following symptoms:
A male patient fell more than 30 feet and landed on his back. The patient is unable to move anything below his shoulders. Which of the following describes this patient’s inability to move parts of his body?
A. Hemiplegia
B. Quadriplegia
C. Paraplegia
D. Monoplegia
Correct answer: Quadriplegia
Quadriplegia (also known as tetraplegia) affects both arms and both legs. Monoplegia affects a single arm or leg, and hemiplegia affects an arm and leg on the same side of the body.
In this scenario, the patient cannot feel anything below his shoulders, which indicates quadriplegia.
Return of spontaneous circulation (ROSC) has been achieved in a previously pulseless apneic adult patient. What is the most appropriate next step?
A. Reanalyze the patient's cardiac rhythm
B. Resume CPR, beginning with chest compressions
C. Assess the patient's breathing
D. Immediately transport the patient
Correct answer: Assess the patient's breathing
ROSC is defined as the return of spontaneous circulation (pulse) in a patient recovering from cardiac arrest. ABCs should be followed with airway and breathing assessments after ROSC is achieved. If the patient is not breathing adequately, assisted ventilation should be administered. If the patient is breathing adequately, high-flow oxygen via a non-rebreather mask should be provided.
It is not appropriate to resume CPR or reanalyze the cardiac rhythm of a patient with a pulse and effective blood flow.
Which of the following is not part of the minimum information collected by dispatch for an emergency request?
A. Any potential hazards
B. The nature of the call
C. The age of the patient
D. Is the patient conscious and breathing
E. Additional information reference to call history at the location
Correct answer: Additional information reference to call history at the location
Dispatch must be easy to access and in service for 24 hours a day. Operation responsibilities and jurisdiction will differ by location. Trained personnel who are familiar with the service area geography should provide dispatch services for their respective region. For each emergency request, a dispatcher should obtain and record the following:
A shooting has occurred at a local mall. Police are already on the scene, searching for the shooter. A person who has been shot can be seen through the store window.
What is the appropriate next step?
A. Ask dispatch whether the scene is safe
B. Request armed cover for law enforcement to enter and retrieve the patient
C. Ask the fire command via radio if the scene is safe
D. Await police instructions on whether the scene is safe.
Correct answer: Await police instructions on whether the scene is safe
If violence is likely or obvious, police should be involved. It is important to ensure scene safety prior to entering. Instructions given by police regarding the status of and continuation of scene safety should be followed.
Dispatch or fire command may not have scene safety information. At a scene involving violence, law enforcement will be in command.
Which of the following suggests a subdural hematoma?
A. Unexplained palpitations
B. Altered mental status
C. Difficulty breathing
D. Sudden loss of consciousness
Correct answer: Altered mental status
A subdural hematoma is a collection of blood due to rupture of " bridging veins" between the dura mater and the arachnoid membrane (surrounding the cerebral cortex). It is the most common type of traumatic intracranial hematoma, and its presentations vary widely. It can occur after a fall or strong deceleration force injury or after seemingly insignificant head trauma in an elderly person on anticoagulation therapy.
The clinical presentation depends on the location of the lesion and the rate at which it develops. Patients often develop altered mental status. Other symptoms of subdural hematoma can include a headache, dizziness, nausea and vomiting, lethargy or excessive drowsiness, weakness, apathy, and seizures.
A sudden loss of consciousness is rare with a subdural hematoma but more likely in an epidural hematoma. Signs of a subdural hematoma generally have a gradual onset.
Numerous disorders can cause abnormal bleeding and bruising, including platelet dysfunction, thrombocytopenia, clotting factor deficiencies, and factor inhibitors.
In 85% of cases, dyspnea is due to asthma, pneumonia, cardiac ischemia, interstitial lung disease, congestive heart failure, chronic obstructive pulmonary disease, or a panic attack.
Palpitations are sensations of a rapid or irregular heartbeat and are primarily caused by cardiac arrhythmias or anxiety.
A 23-year-old female is breathing at a rate of 45 breaths per minute and is visibly upset. She has no known medical conditions and takes no medications. She reports numbness and tingling in her hands. From which of the following is the patient most likely suffering?
A. Aspirin overdose
B. Hyperventilation
C. Diabetic ketoacidosis
D. Pneumonia
Correct answer: Hyperventilation
Hyperventilation is over-breathing (above a normal respiration rate), reducing arterial carbon dioxide. Hyperventilation may occur due to an elevated level of carbon dioxide, such as in diabetic ketoacidosis, an overdose of aspirin, or a severe infection.
Hyperventilation may also occur with anxiety, dizziness, numbness/tingling, and painful spasms in the hands and feet due to excess loss of carbon dioxide; this condition is known as hyperventilation syndrome or respiratory alkalosis. Instructing a responsive patient to slow their breathing, giving supplemental oxygen, and providing transport are appropriate when hyperventilation is occurring.
Diabetic ketoacidosis is a possible cause of hyperventilation; however, an altered mental status, body aches, abdominal pain, and nausea/vomiting may also occur.
Signs and symptoms of pneumonia vary, depending on the patient and the severity of the illness; typically, dyspnea and fever occur. A productive cough, chest discomfort, headache, nausea/vomiting, musculoskeletal pain, weight loss, and confusion are possible.
There is no indication the patient has overdosed on aspirin.
Which of the following patients should not be treated with CPAP?
A. A patient with pulmonary edema
B. A patient with facial trauma
C. A patient in respiratory distress
D. A patient with an SpO2 of 84%
Correct answer: A patient with facial trauma
Contraindications for CPAP (Continuous Positive Airway Pressure) include:
Respiratory distress, pulmonary edema, and hypoxia are all indications that a patient may need CPAP.
Vital signs were not obtained from a patient when required. Which of the following is the appropriate action to remedy the situation?
A. Document that vital signs were not available.
B. Document that vital signs were not obtained and the reason.
C. Document that the patient refused to have Vital Signs obtained.
D. Make all values for the set of Vital Signs is zero.
Correct answer: Document that vital signs were not obtained and the reason
Every action, procedure, intervention, and assessment that is performed should be documented; if a required action is not completed, note that it was not completed as well as the reason. If the patient refused vital signs, you would document this event, but in this case, the EMS provider failed to obtain them.
Never ignore errors that have occurred, whether in documentation or action. Do not use values (e.g., zero, previous numbers) that do not correlate with the actual values of an assessment at that time.
Which of the following patients should be placed on high-flow oxygen via a non-rebreather mask?
A. A 65-year-old female with a respiratory rate of 18 breaths per minute who is exhibiting restlessness and tachycardia.
B. A responsive 50-year-old male who is breathing eight times per minute and has blue lips.
C. An alert three-year-old female who is breathing at a rate of 26 breaths per minute with adequate depth and pink lips.
D. A 40 year old male with a respiratory rate of 36 breaths per minute and shortness of breath.
Correct answer: A 65-year-old male with a respiratory rate of 18 breaths per minute who is exhibiting restlessness and tachycardia
Restlessness, irritability, apprehension, tachycardia, and anxiety are early signs of hypoxia. Late signs of hypoxia include altered mental status, a weak/thready pulse, and cyanosis. A non-rebreather mask should be used for patients with adequate breathing who have suspected or confirmed hypoxia. A patient in severe respiratory distress/failure requires assisted ventilation (e.g., a bag-valve mask). Signs of respiratory distress include tachypnea/ bradypnea, an irregular rhythm, diminished or noisy breath sounds, reduced air flow, unequal/inadequate chest expansion, use of accessory muscles, shallow depth, retractions, or skin that is pale, cyanotic, cool, or moist.
A 40-year-old male with a respiratory rate of 36 is in respiratory distress and requires assisted ventilation with a bag valve mask.
A 50-year-old male with bradypnea is not adequately ventilating and needs assisted ventilation with a bag valve mask.
This three-year-old female is breathing at an adequate rate.
Which of the following diabetic patients would likely benefit from the administration of oral glucose?
A. A confused patient who is cool and clammy with a patent airway.
B. An unconscious patient who may have accidentally taken too much insulin.
C. A confused patient with hemiparesis and dysphagia.
D. An alert and oriented patient who has hot and dry skin.
Correct answer: A confused patient who is cool and clammy with a patent airway
Oral glucose is indicated for patients with hypoglycemia. A patient who does not require oral glucose will not be harmed by it, so it should be given if hypoglycemia is suspected. Hypoglycemia often causes a rapid onset of altered mental status, particularly in a patient with a history of diabetes. Other signs and symptoms include pale, cool, moist skin; hypotension; a rapid, weak pulse; and possibly shallow respirations in severe cases. Oral glucose should not be given to an unresponsive/unconscious patient or a patient without a gag reflex due to the risk of aspiration.
Dysphagia is difficulty swallowing or an inability to swallow; therefore, this patient is at risk for aspiration of any medication.
Hot, dry skin is not a common symptom of hypoglycemia, so this patient will not likely benefit from oral glucose administration.
Which of the following is an indication for humidified oxygen?
A. Extended transport
B. Dyspnea
C. Respiratory Arrest
D. COPD Exacerbation
Correct answer: Extended transport
Humidified oxygen is generally used for extended transport or specific conditions, such as croup. Dry oxygen is not considered harmful for short-term use. An oxygen humidifier consists of a small, single-patient-use bottle of water through which tubing for oxygen flows before it reaches the patient. Always defer to guidance from medical direction or local protocols.
Chronic obstructive pulmonary disease (COPD) exacerbations, dyspnea, and respiratory arrest are not necessarily indications for humidified oxygen therapy.
A 67-year-old female complains of chest pain. Her skin is cool to the touch and clammy. She states her chest feels very tight during inhalation. Which of the following is the most appropriate next step?
A. Ask about past medical history to determine the likelihood of a true cardiac event.
B. Place it automated external defibrillator, as the patient is likely to become pulseless.
C. Administer high flow oxygen.
D. Assist the patient in applying her husband's nitroglycerin paste to her chest.
Correct answer: Administer high-flow oxygen.
History taking is appropriate, but oxygen should not be delayed in this particular scenario.
For a patient with chest pain, administration of high-flow oxygen is completed early. Oxygen should be titrated to achieve an oxygen saturation between 95% and 99%. A nasal cannula may be all that is required for patients with mild dyspnea; more serious respiratory difficulty calls for a non-rebreather mask.
An elderly patient is in cardiac arrest, and a family member presents a do-not-resuscitate (DNR) order. Which of the following is commonly required for a DNR to be valid?
A. List of medications
B. Events leading to cardiac arrest
C. List of medical problems
D. List of allergies
Correct answer: List of medical problems
DNR orders instruct responders not to attempt resuscitation for a patient. In order to be valid, a DNR must articulate the following requirements:
A DNR order does not mean "do not treat;" EMS providers are still obligated to provide supportive measures (e.g., oxygen, pain relief, and comfort).
A patient's medications, allergies, and events leading to cardiac arrest are not required for DNR validity.
Which of the following patients would not be considered a high priority?
A. An unconscious 29-year-old who is thrown from a horse.
B. A conscious and alert 18-year-old with lower extremity contusions and epistaxis after a bicycle accident.
C. A 30-year-old who is ejected from a car during a high-speed collision with a suspected cervical spine injury.
D. A responsive 24 year old unrestrained driver of a vehicle who is unable to follow commands
Correct answer: A conscious and alert 18-year-old with lower extremity contusions and epistaxis after a bicycle accident
High-priority patients require rapid transport. Examples of high-priority patients include those who are unresponsive, are responsive but unable to follow commands, provide a poor general impression, have difficulty breathing, have uncontrolled bleeding, have severe chest pain, have severe pain in any area of the body, have pale skin/signs of poor perfusion, are pregnant with likely complicated childbirth, or experienced a significant mechanism of injury.
Significant mechanisms of injury include injury to more than one body system; falls from heights; high-speed motor vehicle, ATV, or motorcycle crashes; car-pedestrian accidents; gunshot wounds; and stabbings.
The 18-year-old's injuries are superficial and not life-threatening.
Which of the following are risk factors for sudden infant death syndrome (SIDS)?
Select the THREE correct answer options.
Select Three:
A. Lower Socioeconomic Class
B. Maternal age over 40 years
C. Maternal age younger than 20 years
D. Maternal smoking during pregnancy or after birth
E. Low birth weight
Although it is impossible to predict SIDS definitively, the following are several known risk factors:
Socioeconomic class is not a risk factor for SIDS, as this condition affects all races and socioeconomic classes equally. Maternal age over 40 has been associated with risk factors for the mother during pregnancy but is not a risk factor for SIDS.
Which of the following patients has the highest score on the Glasgow Coma Scale?
A. A 49 year old male who opens his eyes to painful stimuli, does not respond to speech and has no motor to response to verbal commands or painful stimuli.
B. A 24-year-old female who opens her eyes in response to speech, responds with inappropriate words, and withdraws from painful stimuli.
C. A 51 year old female who opens her eyes to painful stimuli, respond with incomprehensible sounds, and withdraws from painful stimuli.
D. A 30-year-old who maintains eye contact, respond with incomprehensible sounds, and follows basic commands.
Correct answer: A 30-year-old male who maintains eye contact, responds with incomprehensible sounds, and follows basic commands
The Glasgow Coma Scale (GCS) is an evaluation tool that is used to determine the level of consciousness. It evaluates eye opening, verbal response, and motor response. A lower score suggests more severe brain injury. Survivability is not assessed with GCS but via the Revised Trauma Score.
Eye opening is scored as follows:
Verbal response is scored as follows:
Motor response is scored as follows:
A 45-year-old male complains of chest pain. He has a heart condition and took a nitroglycerin tablet about 10 minutes ago; the tablet provided minor relief. After an assessment of his vital signs, which of the following is the appropriate order of interventions?
A. Give the patient 81 mg of aspirin, contact medical control, administer oxygen at 15 L per minute, and perform a thrombolytic screen.
B. Administer oxygen as needed to maintain oxygen saturation between 95% and 99%, contact medical control, and requests permission to assist the patient in taking another nitroglycerin if his systolic blood pressure is above 100 mmHg.
C. Have the patient lie on the stretcher to determine cardiac relation to the pain, contact medical control for permission to assist the patient in taking more nitroglycerin if his systolic blood pressure is above 100 mmHg, and apply oxygen at 6 L per minute.
D. Since the patient received some relief, instruct him to continue to take nitroglycerin and then call 911 again if the pain returns, have him sign a refusal, and return to service.
Correct answer: Administer oxygen as needed to maintain oxygen saturation between 95% and 99%, contact medical control, and request permission to assist the patient in taking another nitroglycerin if his systolic blood pressure is above 100 mm Hg
Oxygen should be administered based on the patient's presentation. A nasal cannula will be sufficient for some patients, whereas patients with breathing difficulty may require high flow on a non-rebreather mask. Administer oxygen with a SpO2 oximetry goal of 94-98%. If possible, place the patient in a position of comfort, such as the Fowler or semi- Fowler position.
Aspirin may benefit this patient (the correct dose is 324 mg), but medical direction should be obtained prior to interventions that are not part of protocol. As with any medication, inquiries about allergies should be made prior to administration.
Some services will use a thrombolytic screen, but these do not take precedence over patient care.
His previous positive response to nitroglycerin suggests that a follow-up dose may be warranted; medical direction should be obtained prior to assisting with a repeat dosing. Systolic blood pressure below 100 mm Hg is one of several contraindications to nitroglycerin, so vital signs must be assessed prior to administration.
There is no indication that the patient is refusing treatment.
Which of the following is not considered a normal role or responsibility of an emergency medical technician (EMT)?
A. Maintaining continuity of care.
B. Delegating the authority to provide medical care in the field.
C. Performing patient assessments
D. Ensuring and protecting patient privacy.
Correct answer: Delegating the authority to provide medical care in the field
An EMT has training in basic life support, such as automated external defibrillation, the use of definitive airway adjuncts, and the assistance of patients with certain medications. Their general roles and responsibilities include the following:
A medical director is a physician who authorizes or delegates authority to EMTs to provide medical care in the field.