Call The Midwife
A full-term patient has contractions two minutes apart and says there is a strong urge to push. What assessment finding confirms that delivery is imminent?
What is crowning at the vaginal opening?
The umbilical cord is wrapped tightly around the newborn’s neck and cannot be slipped over the head. What should the EMT do?
What is Clamp the cord in two places, cut between the clamps, and continue the delivery?
A newborn is apneic with a heart rate of 80 per minute after drying, warming, positioning, and stimulation. What is the next intervention?
What is Begin positive-pressure ventilation with a BVM at an appropriate neonatal rate?
A caregiver says a child’s tracheostomy tube may be obstructed. The child is cyanotic with poor air movement. What should the EMT prioritize?
What is Open and clear the airway using the patient’s emergency plan and available tracheostomy equipment, then ventilate as needed?
At a crash scene, a leaking tanker displays a hazardous-material placard and several bystanders are coughing. What should the EMT do before approaching?
What is Stage uphill and upwind, deny entry, identify the hazard from a safe distance, and request HazMat resources?
A suspected opioid-overdose patient has a pulse but breathes four times per minute. Naloxone is ready. What intervention comes first?
What is open the airway and provide BVM ventilations with oxygen?
A patient has bright-red blood spurting from a leg wound. Firm direct pressure has not controlled it. What should the EMT do next?
What is apply a tourniquet proximal to the wound and tighten until bleeding stops?
During a normal delivery, the head delivers and immediately turns to one side. What should the EMT do next?
What is Check for a nuchal cord, then guide delivery of the shoulders without pulling on the infant?
An umbilical cord is visible at the vaginal opening before the infant. What is the immediate treatment?
What is Relieve pressure from the presenting part with a gloved hand, position the patient knee-chest or hips elevated, give oxygen as indicated, and transport rapidly?
After 30 seconds of effective positive-pressure ventilation, a newborn’s heart rate remains 50 per minute. What should the resuscitation team do next?
What is Begin chest compressions coordinated with ventilations at a 3:1 ratio and request advanced support?
A ventilator-dependent patient is in respiratory distress and the home ventilator is alarming. What is the safest immediate action if the cause cannot be corrected quickly?
What is Disconnect from the ventilator and provide manual BVM ventilation through the airway device?
An unresponsive patient has snoring respirations after a fall. What should occur before obtaining a detailed history?
What is Open the airway with spinal precautions and assess ventilation?
A patient with asthma becomes quiet and drowsy after prolonged wheezing. Breath sounds are now barely audible. What does this change indicate?
What is Impending respiratory failure with severely reduced air movement?
A patient has a deep groin wound with severe bleeding that cannot be controlled by surface pressure. What is the best intervention?
What is Pack the junctional wound with hemostatic gauze and maintain firm pressure?
A newborn has just delivered and is vigorous. List the immediate routine care priorities before calculating an APGAR score.
What is Warm, dry, position the airway, stimulate as needed, and assess breathing and heart rate?
A breech infant delivers to the shoulders, but the head does not deliver and the infant’s body begins to turn blue. What airway maneuver may be lifesaving while awaiting rapid transport?
What is Create an airway space by placing gloved fingers along the infant’s face to lift the vaginal wall away from the nose and mouth?
A newborn’s heart rate rises from 50 to 90 during coordinated compressions and ventilation. What should be stopped, and what should continue?
What is Stop chest compressions and continue positive-pressure ventilation?
A patient with an implanted ventricular assist device is awake but has no palpable pulse and the monitor cannot obtain a blood pressure. What finding should guide the EMT’s decision about CPR?
What is assess perfusion and device function; do not start CPR solely because a pulse is absent?
A patient with severe dyspnea is speaking one word at a time, has poor chest rise, and a respiratory rate of 34. Oxygen saturation is 94%. What finding determines the treatment priority?
What is inadequate work of breathing and ventilation, not the near-normal pulse oximetry reading?
A patient has sudden vertigo, vomiting, severe gait instability, and limb ataxia but no facial droop or arm drift. What time-sensitive diagnosis must be suspected?
What is a posterior circulation or cerebellar stroke?
A patient with paradoxical chest-wall movement has shallow respirations and falling oxygen saturation. What treatment addresses the immediate threat?
What is provide BVM ventilatory support with oxygen when respirations are inadequate?
A patient at 39 weeks has regular contractions, but the presenting part is not visible. The patient has no urge to push and transport time is 12 minutes. What is the best plan?
What is Transport in a position of comfort while monitoring for rapid progression and preparing for delivery?
A pregnant patient in the third trimester has painless, bright-red vaginal bleeding. Which condition should be suspected, and what examination should not be performed?
What is Suspect placenta previa; do not perform a vaginal examination?
A newborn is pink in the torso but has blue hands and feet, a strong cry, good tone, and a heart rate of 140. What is the best interpretation?
What is This is expected acrocyanosis; continue routine newborn care and warming?
A nonverbal patient with autism becomes increasingly agitated when multiple responders speak and touch the patient. What change is most appropriate?
What is Use one calm communicator, reduce stimulation, explain before touching, and involve the caregiver?
After treatment, a patient’s respiratory rate falls from 32 to 18, but the patient becomes drowsy and has less chest movement. Is this improvement?
What is No; this suggests respiratory fatigue and impending failure?
A dialysis patient who missed treatment has weakness, nausea, and a slow irregular pulse. Which electrolyte emergency should the EMT suspect?
What is Hyperkalemia?
A patient with an isolated closed midshaft femur fracture also has intact distal circulation. Which splint is most appropriate?
What is a traction splint?
Immediately after delivery, the uterus feels soft and the patient has heavy vaginal bleeding. What should the EMT do first?
What is Massage the uterine fundus and provide shock care while transporting rapidly?
A patient at 36 weeks has sudden severe abdominal pain, dark vaginal bleeding, a rigid tender abdomen, and signs of shock. What diagnosis is most likely?
What is placental abruption?
A premature newborn is breathing spontaneously but has weak tone and rapidly loses body heat. What management priority is easily overlooked but essential?
What is aggressive prevention of heat loss while supporting breathing and monitoring closely?
A patient with a chronic neurologic disorder has an advance directive and a portable medical order limiting resuscitation. The caregiver demands full resuscitation after the patient becomes pulseless. What should the EMT do?
What is Follow the valid medical order and local protocol while contacting medical direction when clarification is needed?
A competent adult with a potentially serious condition refuses transport after risks and alternatives are explained. What documentation element is most important beyond obtaining a signature?
What is Document decision-making capacity, the assessment, information and risks explained, alternatives offered, and the patient’s stated refusal?
A patient with fever and recent infection is confused, tachycardic, tachypneic, hypotensive, and initially warm and flushed. What type of shock is most likely?
What is Distributive shock from sepsis, or septic shock?
A patient with head trauma has hypertension, bradycardia, and irregular respirations. Name this pattern and what it indicates.
What is Cushing triad, indicating severely increased intracranial pressure?