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EMT Final Exam JBL Study Guide: Essential Concepts and Practice Questions, Exams of Advanced Education

This study guide provides a comprehensive overview of key concepts and practice questions for emt final exams. It covers essential topics such as heatstroke, vehicle collisions, chemical eye burns, impaled objects, aed errors, asthma attacks, open chest wounds, hyperglycemic ketoacidosis, respiratory distress, cardiac arrest, and nitroglycerin side effects. The guide is designed to help emt students prepare for their final exams by providing a structured approach to learning and reviewing important concepts.

Typology: Exams

2024/2025

Available from 12/08/2024

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EMT FINAL EXAM JBL STUDY GUIDE

According to the USDOT, minimum staffing for BLS ambulance includes: - At least one EMT in the patient compartment. The driver does not need to be an EMT Which of the following statements regarding heatstroke is correct? - Heatsrtoke occurs when the body is exposed to more heat than it can eliminate and normal mechanisms such as sweating are overwhelmed. The temp can rise to appoint where tissues are destroyed. It can develop during prolonged vigorous physical activity or in closed, poorly ventilated, hot and humid space. High humidity impairs heat elimination via sweating. Patients will have hot, dry, flushed skin, become agitated, and LOC will decrease If a vehicle strikes a tree at 60 mph, the unrestrained driver would likely experience the MOST severe injuries during the: - Motor-vehicle crashes typically consist of three separate collisions. Understanding the events that occur during each collision will help you remain alert for certain types of injury patterns. During the first collision, the vehicle strikes another object. Damage to the car is perhaps the most dramatic part of the collision, but it does not directly affect patient care. It does, however, provide information about the severity of the collision; thus, it has an indirect effect on patient care. During the second collision, the passenger collides with the interior of the vehicle. Just like the obvious damage to the exterior of the car, the injuries that result are often dramatic and usually apparent during your primary assessment. During the third collision, the occupant's internal organs collide with the solid structures of the body. Although the injuries that occur during the third collision may not be as obvious as those that occur during the second collision, they are often the most life-threatening. A 22-year-old man had a strong acid chemical splashed into both of his eyes. He is conscious and alert, is experiencing intense pain, and states that he is wearing contact lenses. Treatment should include: - As a general rule, contact lenses should be left in place. Chemical eye burns are an exception to this rule. If left in place, the chemical could get behind the contact lens and continue to cause injury. Therefore, you should remove the contact lenses and immediately irrigate the eyes with sterile saline or water. If needed, continue to irrigate the eyes throughout transport. A 22-year-old male has a shard of glass impaled in his cheek. You look inside his mouth and see minor bleeding. The patient is conscious and alert with adequate breathing. You should: - It remains true that you should remove an impaled object if it compromises the airway or impedes your ability to manage the airway. However, neither is the case with this patient because he has an adequate airway. He is conscious and alert and has only minor bleeding in his mouth. The safest approach, and most practical given the situation, would be to carefully stabilize the shard of glass in place; consider wrapping the exposed glass with gauze to protect yourself from getting cut. Since the patient is conscious and alert and has only minor oral bleeding, it would not be unreasonable to hand him the suction catheter and allow him to use it as needed. Be sure to instruct the patient to use the suction and not to swallow any blood.

Keep in mind that if you attempt to remove the shard of glass, you risk cutting yourself and causing further injury to the patient. When an error occurs while using the AED, it is MOST often the result of: - AEDs are highly sensitive and specific in recognizing shockable rhythms (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. 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: - 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. Upon discovering an open chest wound, you should: - Upon discovering an open chest wound (ie, sucking chest wound), you must take immediate action to prevent air from entering the wound. This is most effectively accomplished by applying an occlusive dressing or similar material to the wound. A porous (non-occlusive) trauma dressing will not prevent air from entering the wound. Tape three sides of the occlusive dressing and closely monitor the patient. If worsened respiratory distress and signs of shock are noted, a tension pneumothorax is probably developing, and you must release pressure from the pleural space by lifting up the unsecured portion of the occlusive dressing. Which of the following signs and symptoms are MOST characteristic of hyperglycemic ketoacidosis? - Hyperglycemic ketoacidosis (diabetic coma) is characterized by a dangerously high blood glucose level (hyperglycemia); slow onset; warm, dry skin (from dehydration); Kussmaul's respirations, which are deep and rapid; and breath with a fruity or acetone odor. Insulin shock results from a low blood glucose level (hypoglycemia) and is characterized by a rapid onset; altered mental status; and cool, clammy skin. You are assessing an elderly man with respiratory distress. He is coughing up bloody sputum and has an oxygen saturation of 85%. You auscultate his breath sounds and hear coarse crackles in all lung fields. This patient MOST likely has: - This patient's signs and symptoms are classic for left-sided congestive heart failure and pulmonary

edema. As the left side of the heart weakens, so that it can no longer effectively pump blood, blood backs up into the lungs, resulting in pulmonary edema. As pulmonary edema gets worse, the patient begins coughing up pink, frothy sputum (hemoptysis). The presence of fluid in the lungs impairs the exchange of oxygen and carbon dioxide, resulting in hypoxemia and a low oxygen saturation (SpO2). Auscultation of the patient's lungs often reveals coarse crackles, which indicates the presence of fluid. Emphysema is a chronic respiratory disease, not an acute one. Furthermore, hemoptysis is not a common finding with emphysema. Likewise, patients with decompensated asthma often have markedly diminished lung sounds owing to severe bronchospasm; hemoptysis and crackles are not common. Bacterial pneumonia can cause respiratory distress; however, it usually presents with fever and diminished breath sounds to a localized area of a lung (eg, the left lower lobe). After an adult cardiac arrest patient has been intubated by a paramedic, you are providing ventilations as your partner performs chest compressions. When ventilating the patient, you should: - When ventilating an adult cardiac arrest patient with an advanced airway in place (ie, ET tube, multilumen airway, supraglottic airway), you should deliver each breath over a period of 1 second--just enough to produce visible chest rise--at a rate of 10 breaths/min (one breath every 6 seconds). Do not attempt to synchronize ventilations with chest compressions once the airway has been secured with an advanced device. Hyperventilation should be avoided, as it may result in increased intrathoracic pressure, decreased blood return to the heart, and, as a result, less effective chest compressions. Which of the following is a common side effect of nitroglycerin? - Because nitroglycerin (NTG) causes vasodilation, including the vessels within the brain, cerebral blood flow increases following its administration. 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. A 56-year-old man has labored, shallow breathing at a rate of 28 breaths/min. He is responsive to pain only. You should: - 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-valve-mask device. When assisting a patient's breathing, you should squeeze the bag-valve-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.

ou are assessing a 66-year-old man who has emphysema and complains of worsened shortness of breath. He is confused, has a heart rate of 120 beats/min, and has an oxygen saturation of 83%. Which of the following assessment findings should concern you the MOST? - All of your assessment findings in this patient are significant. Worsened shortness of breath in a patient with a preexisting respiratory disease could indicate exacerbation of his or her condition or a new problem. Tachycardia and a low oxygen saturation (SpO2) are signs of hypoxemia, a low level of oxygen in arterial blood. Of all the patient's assessment findings, the fact that he is confused should concern you the most. Altered mentation in a patient with respiratory distress indicates that the brain is not getting enough oxygen and that carbon dioxide is accumulating in the blood. It is important to recognize the signs of hypoxemia and begin immediate treatment (eg, high-flow oxygen via a nonrebreathing mask, assisted ventilation) to prevent hypoxia, a dangerous condition in which the body's cells and tissues do not receive enough oxygen. Left untreated, hypoxia may cause permanent brain damage or death. Hypoxia is defined as: - Hypoxia is a dangerous condition in which the body's cells and tissues do not have enough oxygen. Hypoxemia is a decreased amount of oxygen in arterial blood. Untreated hypoxemia will lead to hypoxia. An absence of oxygen to any part of the body is called anoxia. An excess amount of carbon dioxide in arterial blood is called hypercarbia. If the body cannot bring in enough oxygen, it is also unable to eliminate carbon dioxide from the blood; therefore, hypoxemia and hypercarbia occur together. Which of the following devices is contraindicated in patients with blunt thoracic trauma?

  • The oxygen-powered ventilator, also called a manually triggered ventilator, should not be used in patients with chest trauma; it delivers oxygen under high pressure and may worsen the patient's injury. Oxygen-powered ventilators are also associated with a high incidence of gastric distention. They are also contraindicated in pediatric patients and in patients with COPD. Infants and children have small lungs; the high ventilatory pressure delivered by the oxygen-powered ventilator can cause a pneumothorax. Patients with COPD often have air trapped in their lungs; excessive ventilatory pressure may cause alveolar rupture or a pneumothorax. A 60-year-old man complains of 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, respirations are 24 breaths/min and labored, and oxygen saturation is 93%. You ask him if has taken any nitroglycerin and he tells you that he does not have any but his wife does. You should: - If a patient with suspected cardiac compromise does not have prescribed nitroglycerin (NTG), complete your focused physical examination, continue oxygen therapy (if indicated), 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. 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: - 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. During the inhalation phase of breathing: - Inhalation is the active, muscular part of breathing. During inhalation, the diaphragm and intercostal muscles contract. When the diaphragm contracts, it moves down (descends) slightly and enlarges the thoracic cage from top to bottom. Contraction of the intercostal muscles, the muscles in between the ribs, causes the ribs to move up and out. As we inhale, the combined actions of these structures enlarge the thorax in all directions. The air pressure outside the body, called the atmospheric pressure, is normally higher than the air pressure within the thorax. As we inhale and the thoracic cage expands, the air pressure within the thorax decreases, creating a slight vacuum. This draws air in through the trachea and into the lungs, a process called negative-pressure ventilation. Sudden cardiac arrest in the adult population is MOST often the result of: - 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. A 35-year-old patient complains of shortness of breath. He is conscious and alert and is able to speak in complete sentences, although with slight difficulty. Assessment reveals diffuse wheezing to auscultation, a respiratory rate of 24 breaths/min, a heart rate of 110 beats/min, and an oxygen saturation of 96%. Which of the following interventions would be of MOST benefit to this patient? - The patient's clinical presentation is classic for bronchospasm, such as what occurs with asthma. The primary treatment for wheezing is an inhaled bronchodilator (beta agonist), which will dilate the bronchioles and make it easier to breathe. Additional bronchodilator treatment may be needed if his symptoms do not improve. Oxygen is not indicated for this patient because his oxygen saturation is greater than 94%, and he is not in need of assisted ventilation because he has no outward signs of inadequate breathing.

In addition to chest pain or discomfort, a patient experiencing an acute coronary syndrome would MOST likely present with: - Chest pain, pressure, or discomfort is the most common symptom of acute coronary syndrome (ACS; eg, unstable angina, acute myocardial infarction); it occurs in approximately 80% of cases. Patients with ACS are usually anxious and may have a feeling of impending doom. Nausea and vomiting are common complaints; however, projectile vomiting, which is typically associated with increased intracranial pressure, is uncommon. The skin is often ashen gray and clammy (diaphoretic) because of poor cardiac output and decreased perfusion. Less commonly, the patient's skin is cyanotic. Respirations are usually unlabored unless the patient has congestive heart failure, in which case respirations are rapid and labored; irregular breathing, however, is not common. Blood pressure may fall as a result of decreased cardiac output; however, most patients will have a normal or elevated blood pressure. If the patient complains of a headache, it is usually a side effect of the nitroglycerin he or she took before your arrival; ACS itself usually does not cause a headache. Following delivery of a newborn and placenta, you note that the mother has moderate vaginal bleeding. The mother is conscious and alert, and her vital signs are stable. Treatment for her should include: - Postpartum bleeding is most effectively controlled by massaging the fundus (top) of the uterus. Uterine massage stimulates the pituitary gland to secrete a hormone called oxytocin, which constricts the blood vessels in the uterus and helps stop the bleeding. Do not wait for signs of shock to develop before performing uterine massage. The goal is to control the postpartum bleeding and thereby prevent shock. Administer supplemental oxygen as needed, begin transport, and monitor the patient for signs of shock (ie, tachycardia, pallor, diaphoresis, tachypnea) en route. Vaginal bleeding is never treated by placing anything inside the vagina; this action increases the risk of maternal infection. Oxygen that is administered through a nasal cannula would be of LEAST benefit to a patient who: - A patient who breathes through the mouth or has a nasal obstruction will get little or no benefit from a nasal cannula. Many patients with COPD (eg, emphysema, chronic bronchitis) require long-term, low-flow oxygen therapy; the nasal cannula is ideal in this situation. Considering their chronic respiratory problem, an oxygen saturation of 94% in a COPD patient is good; in fact, many COPD patients maintain an oxygen saturation lower than 94%, even with supplemental oxygen. A nasal cannula is appropriate to use in patients breathing more than 12 times per minute, provided they have adequate tidal volume and are not significantly hypoxemic. Regardless of the oxygen delivery device used, you should maintain a patient's oxygen saturation at greater than 94%. After the baby's head delivers, it is usually tilted: - As the baby's head begins to deliver, it is usually in a posterior, face-down position. After the head delivers completely, however, it usually tilts to the side in preparation for delivery of the shoulders. Remember to check for the presence of a nuchal cord (umbilical cord wrapped around the neck), and to suction the baby's mouth and nose as soon as its head delivers.

You are transporting a 35-year-old male who has a history of alcoholism. He stopped drinking 4 days ago and is now disoriented, diaphoretic, and tachycardic. You should be MOST concerned that he: - A patient in alcohol withdrawal may experience frightening hallucinations, or delirium tremens (DTs), a syndrome characterized by restlessness, fever, disorientation, sweating, agitation, and even seizures. About 1 to 7 days after a person stops drinking or when alcohol consumption levels are suddenly decreased, DTs may develop. Patients with DTs are often dehydrated due to sweating, fluid loss, insufficient fluid intake, or vomiting, and their hallucinations can be extremely frightening. However, the possibility of a seizure, clearly the most life-threatening complication associated with DTs, should concern you the most. Which of the following statements regarding the high-efficiency particulate air (HEPA) respirator is correct? - If you are caring for a patient with known or suspected tuberculosis (TB), regardless of whether the patient is coughing, you should place a surgical mask (or high-flow oxygen, if indicated) on the patient and a high-efficiency particulate air (HEPA) respirator (N-95 or higher) on yourself. Unlike a surgical mask, the HEPA respirator is specifically designed to prevent exposure to the bacterium that causes TB. A surgical mask, however, will reduce the transmission of germs from the patient into the air. Do not place a HEPA respirator on the patient; it is unnecessary and uncomfortable. Use of a HEPA respirator should comply with OSHA standards, which state that facial hair, such as long sideburns or beards, will prevent a proper fit. Which of the following would MOST likely cause a rapid drop in a patient's blood glucose level? - 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 cells. 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 cells and will accumulate in the bloodstream (hyperglycemia). A patient presents with a swollen, painful deformity to the lateral bone of the left forearm. You should recognize that he has injured his: - Recalling the body in the anatomic position, the radius is the lateral (thumb side) bone of the forearm and the ulna is the medial (pinky side) bone. The humerus is the long bone of the upper arm and the clavicle is the collarbone, which extends from the sternum laterally to the shoulder. When using the power lift to lift a stretcher, you should: - To achieve the best grip and to avoid injury to your wrists, you should lift a stretcher, backboard, or other carrying device with your palms facing up. Do not bend at the waist; rather, bend at the knees and keep your back in a straight, locked-in position.

Who has ultimate authority for all issues regarding patient care at the scene of a mass- casualty incident? - The incident commander (IC) is responsible for all logistical and operational aspects of a mass-casualty incident (MCI), such as designating section officers and working in collaboration with other agencies (eg, police, fire, EMS). For all issues regarding patient care, the EMS medical director has ultimate authority. Although the treatment officer is responsible for overseeing all emergency care provided at the scene, and EMTs working in the treatment area provide direct patient care, these personnel are still functioning under the physician's license. During an MCI, the IC (or his or her designee) is typically in contact with the medical director, who is located at the base station hospital, via mobile phone or two-way radio. In some cases, the medical director may be physically present at the incident. 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 dies. Which of the following statements regarding this scenario is MOST correct? - 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 your own and your partner's shoulders. 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 1500 psi, how long will it take before you need to replace the oxygen cylinder? - 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: 1500 (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 2000 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 backup 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). In most people, the inferior aspect of the left ventricle receives its blood supply from the:

  • The right coronary artery (RCA) supplies blood to the entire right side of the heart; in most people, it also supplies blood to the inferior aspect of the left ventricle. The left

main coronary artery branches into the left anterior descending (LAD) and circumflex arteries. The LAD artery supplies the ventricular septum and the anterior aspect of the left ventricle. The circumflex artery supplies the lateral and posterior aspects of the left ventricle. Which of the following components is NOT part of an injury or illness prevention program? - 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 in CPR, although a valuable service, is not part of a prevention program; CPR is not needed until an injury or illness has already occurred. Which of the following statements regarding the length-based resuscitation tape measure is correct? - There are a number of ways to identify the appropriate size of 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 pounds (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. After restoring a pulse in a cardiac arrest patient, you begin immediate transport. While en route to the hospital, the patient goes back into cardiac arrest. You should: - If you restore a pulse in a cardiac arrest patient, the AED pads should remain attached to the patient's chest during transport in case cardiac arrest recurs en route to the hospital. You should, however, turn the AED off or disconnect the pads from the AED. If cardiac arrest recurs, you should immediately tell your partner to stop the ambulance and assist you as you begin CPR. Remember that the AED will not analyze the cardiac rhythm if the patient is moving. Once your partner is available to assist, you should analyze the cardiac rhythm, defibrillate if indicated, and immediately resume CPR. Contact medical control as soon as possible, but not before performing CPR and defibrillation. A 5-year-old child experienced partial-thickness burns to his head, anterior chest, and both upper extremities. What percentage of his total body surface area has been burned? - According to the pediatric Rule of Nines, the child's head represents 18% of his or her total body surface area (TBSA), the anterior chest represents 9% (the entire anterior torso [chest and abdomen] represents 18%), and each entire upper extremity represents 9%. Therefore, burns to the head, anterior chest, and both upper extremities cover 45% of the child's TBSA. The Rule of Nines is modified for infants and children. The head accounts for 18% of the child's TBSA (9% in adults) because the head is proportionately larger than an adult's. The lower extremities account for 13.5% (some

references cite 14%) of the child's TBSA (18% in adults) because the child's lower extremities are proportionately smaller than an adult's. You are transporting a 30-year-old man who is experiencing an emotional crisis. The patient does not speak when you ask him questions. How should you respond to his unwillingness to speak? - When dealing with a psychiatric patient who is silent and unwilling to speak to you, do not fear the silence. The patient simply does not wish to speak. You should not press the issue, because doing so may upset the patient. You should remain calm until the patient speaks to you, and then respond accordingly. If an adult patient presents with a respiratory rate of 26 breaths/min, your initial action should be to: - 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 and alert and has adequate tidal volume (eg, his or her chest rises adequately with each breath), supplemental oxygen may be indicated, 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-valve-mask ventilation). 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 indicated. You are dispatched to a residence for a 20-year-old male with respiratory distress. When you arrive, you find that the patient has a tracheostomy tube and is ventilator dependent. His mother tells you that he was doing fine, but then suddenly began experiencing breathing difficulty. You should: - If a ventilator-dependent patient experiences a sudden onset of respiratory distress, you should first remove him or her from the mechanical ventilator and begin manual ventilation with a bag-valve-mask device; attach the bag directly to the tracheostomy tube. If the patient improves, you will know that the problem was a malfunction with the mechanical ventilator. If the patient does not improve, the tracheostomy tube is likely plugged with thick mucus secretions and requires suctioning. Unless you are familiar with the mechanical ventilator (most EMTs are not), do not attempt to troubleshoot the device by checking the settings; this simply wastes time. You arrive at the scene where a man fell approximately 40 feet and landed on his head. He is unresponsive, has agonal gasps, and has 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: - 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 with 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 the patient will not survive his injury, his organs can potentially be harvested and save several lives. A 46-year-old man presents with generalized weakness and shortness of breath after he was bitten on the leg by a rattlesnake. His blood pressure is 106/58 mm Hg and his pulse rate is 112 beats/min. In addition to supplemental oxygen, further treatment for this patient should include: - Care for a patient with a bite from a pit viper (rattlesnake, copperhead, water moccasin) includes keeping the patient calm, administering supplemental oxygen, splinting the affected part, and keeping it below the level of the heart. Do NOT apply ice to a snakebite; this will cause local vasoconstriction and may force the venom deeper into the patient's circulation. If a constricting band is applied, it should be proximal to the bite and should be tight enough to slow venous return only, not cut off arterial supply. The wall that separates the left and right sides of the heart is called the: - The septum is the wall that separates the left and right sides of the heart. There is a septum for both the atria and the ventricles. The carina is the bifurcation point of the trachea, and the mediastinum is the space between the lungs in which the heart, great vessels, and a portion of the esophagus lie. The pericardium is the sac that surrounds the heart and contains pericardial fluid. In contrast to the contractions associated with true labor, Braxton-Hicks contractions: - During pregnancy, the mother may experience false labor, or Braxton-Hicks contractions, in which there are contractions but they do not represent true labor. Unlike true labor contractions, Braxton-Hicks contractions do not increase in intensity, are not regular, and are typically alleviated by activity or a change in position. The contractions associated with true labor, once they begin, consistently get stronger and closer together and are regular; a change in position does not relieve the contractions. True labor is also commonly followed by, or in some cases preceded by, a rupture of the amniotic sac (bag of waters) and a pink or red vaginal discharge that is generally accompanied by mucus (bloody show). The lower airway begins at the: - Anatomically, the lower airway begins at the larynx (voice box). The cricoid cartilage is a firm cartilage ring that forms the inferior (lower) part of the larynx. The trachea is connected to the larynx and extends downward to form the left and right mainstem bronchi. The epiglottis is an upper airway structure; it is a leaf-shaped structure above the larynx that prevents food and liquid from entering the trachea during swallowing. Which of the following patients would be MOST in need of a rapid head-to-toe assessment? - A rapid head-to-toe assessment (rapid body scan) is indicated for any patient with abnormal findings in the primary assessment or when the mechanism of injury warrants it. Significant mechanisms of injury include falls in the adult of greater

than 15 feet (or three times the patient's height); penetrating injuries to the head, neck, chest, or abdomen; and multiple long bone fractures, among others. The MOST effective means of preventing the spread of disease is: - 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 (eg, tuberculosis) will decrease your chance of disease exposure. Keeping up-to-date with your immunizations will reduce your risk of contracting certain diseases if you are exposed to them. Which of the following ventilation techniques will enable you to provide the greatest tidal volume AND allow you to effectively assess lung compliance? - Because the EMT uses both of his or her hands to obtain a mask seal, the one-rescuer mouth-to-mask ventilation technique will provide the greatest tidal volume compared to the other methods listed. Furthermore, lung compliance (the ability of the lungs to expand when ventilated) can be effectively assessed because air is directly blown into the patient's lungs from the EMT's mouth. The one-rescuer bag-valve-mask ventilation technique may allow the EMT to get a sense of lung compliance; however, because maintaining an adequate mask-to-face seal is often difficult, less tidal volume can be given relative to the mouth-to-mask technique. The manually-triggered ventilation device (demand valve) provides good tidal volume; however, because it is a mechanical device, it does not allow the EMT to assess lung compliance. Appropriate care for an amputated body part includes all of the following, EXCEPT: - Appropriate care for an amputated body part includes wrapping the part in a sterile dressing and placing it in a plastic bag. Follow your local protocols regarding how to preserve amputated parts. In some areas, dry sterile dressings are recommended for wrapping amputated parts; in other areas, dressings moistened with sterile saline are recommended. Put the bag in a container filled with ice. Lay the wrapped part on a bed of ice; do not pack it in ice or place it in direct contact with ice. The goal is to keep the part cool without letting it freeze or develop frostbite. Freezing may cause cellular and tissue damage, which decreases the chance of successful reattachment. Which of the following patients would MOST likely present with vague or unusual symptoms of an acute myocardial infarction? - Not all patients experiencing acute myocardial infarction (AMI) present with the classic signs and symptoms one would expect. Middle-aged men often minimize their symptoms and attribute their chest pain or discomfort to indigestion. Some patients, however, do not experience any pain. In particular, elderly women with diabetes may present with vague, unusual, or atypical symptoms of AMI; their only presenting complaint may be fatigue or syncope. Do not rule out a cardiac problem just because a patient is not experiencing chest pain, pressure, or discomfort; this is especially true in elderly females with diabetes. An injured patient is assigned a total score of 9 on the GCS. He is assigned a score of 2 for eye opening, a score of 3 for verbal response, and a score of 4 for motor response.

Which of the following clinical findings is consistent with his GCS score? - Opens eyes in response to pain, uses inappropriate words, withdraws from pain Activated charcoal is an example of a(n): - suspension Distributive shock occurs when: - widespread dilation of the blood vessels causes blood to pool in the vascular beds What are the three components of the "perfusion triangle"? - Heart, blood vessels, blood When treating an 80-year-old patient who is in shock, it is important to remember that: - changes in gastric motility may delay gastric emptying, which increases the risk for vomiting Complications associated with chest compressions include all of the following, EXCEPT: - gastric distention CPR is in progress on a pregnant woman. Shortly after manually displacing her uterus to the left, return of spontaneous circulation occurs. Which of the following would MOST likely explain this? - Pressure was relieved from her aorta and vena cava, which improved chest compression effectiveness CPR should be initiated when: - a valid living will is unavailable Signs of a sudden severe upper airway obstruction include all of the following, EXCEPT:

  • forceful coughing The impedance threshold device (ITD) may improve circulation during active compression-decompression CPR by: - limiting the amount of air that enters the lungs during the recoil phase between chest compressions, which results in negative intrathoracic pressure and improved cardiac filling. A 37-year-old female with a history of diabetes presents with excessive urination and weakness of 2 days' duration. Her blood glucose level reads 320 mg/dL. If this patient's condition is not promptly treated, she will MOST likely develop: - irreversible renal failure. A 66-year-old woman experienced a sudden onset of difficulty breathing. She has a history of type 2 diabetes and deep vein thrombosis (DVT). On the basis of her medical history, which of the following should the EMT suspect? - Pulmonary embolism A 75-year-old male with type 1 diabetes presents with chest pain and a general feeling of weakness. He tells you that he took his insulin today and ate a regular meal approximately 2 hours ago. You should treat this patient as though he is experiencing: - a heart attack.

he main function of the endocrine system is to _________. - maintain homeostasis A patient with an altered mental status; high blood glucose levels; and deep, rapid breathing may have a condition known as __________. - diabetic ketoacidosis Which of the following conditions is the diabetic patient at an increased risk of developing? - Blindness Which of the following statements regarding glucose is correct? - The brain requires glucose as much as it requires oxygen. Classic signs and symptoms of hypoglycemia include: - cool, clammy skin; weakness; tachycardia; and rapid respirations. During your assessment of a 19-year-old male, you are told that he is being treated with factor VIII. This indicates that: - he has hemophilia A. Proper procedure for administering oral glucose to a patient includes all of the following, EXCEPT: - ensuring the absence of a gag reflex. Epinephrine stimulates the ________ response, increasing blood pressure and relieving bronchospasm. - sympathetic The effects of epinephrine are typically observed within _________ following administration. - 1 minute The stinger from a honeybee should be: - scraped away from the skin. When an allergic reaction proceeds to life-threatening anaphylaxis, it will usually do so __________. - quickly, within 30 minutes. A 49-year-old male presents with confusion, sweating, and visual hallucinations. The patient's wife tells you that he is a heavy drinker and she thinks he had a seizure shortly before your arrival. This patient is MOST likely experiencing: - delirium tremens. A person who routinely misuses a substance and requires increasing amounts to achieve the same effect is experiencing: - tolerance. The recommended treatment for absorbed or contact poisons includes _________. - safely removing or diluting the poisonous substance An overdose of acetaminophen, the active ingredient in Tylenol, will MOST likely cause:

  • liver failure.

When caring for a known alcoholic patient with severe trauma to the chest and abdomen, you should be concerned that: - internal bleeding may be profuse because prolonged alcohol use may impair the blood's ability to clot. Which of the following sets of vital signs would the EMT MOST likely encounter in a patient with acute cocaine overdose? - BP, 200/100 mm Hg; pulse, 150 beats/min Which of the following statements regarding the Salmonella bacterium is correct? - The Salmonella bacterium itself causes food poisoning. If the victim of a toxicologic emergency vomits, an EMT should _________. - use appropriate personal protective equipment and examine the vomitus for pill fragments or other clues for patient care. Upon assessing a newborn immediately after delivery, you note that the infant is breathing spontaneously and has a heart rate of 80 beats/min. What is the MOST appropriate initial management for this newborn? - Positive-pressure ventilations are indicated in the newborn if he or she is apneic or has gasping respirations, if the heart rate is less than 100 beats/min, or if central cyanosis persists despite the delivery of blow-by oxygen. Chest compressions are indicated if the heart rate is less than 60 beats/min, despite 30 seconds of adequate positive-pressure ventilation. In many cases, the newborn's heart rate will increase to greater than 100 beats/min with adequately performed positive-pressure ventilation. A 40-year-old man has burns to the entire head, anterior chest, and both anterior upper extremities. Using the adult Rule of Nines, what percentage of his total body surface area has been burned? - Using the adult Rule of Nines, the head accounts for 9% of the total body surface area (TBSA), the anterior chest for 9% (the entire anterior trunk [chest and abdomen] accounts for 18%), and the anterior upper extremities for 4.5% each (each entire upper extremity is 9% of the TBSA). On the basis of this, the patient has sustained 27% TBSA burns. 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? - 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 hypoglycemia or hyperglycemia, head trauma, stroke, behavioral crises, drug overdose, and shock, among others. While en route back to your station from the emergency department, you discover that you forgot to include vital patient information on the front of your patient care report (PCR). Having left a copy of your PCR with the emergency department staff, you should: - Once you leave a copy of your patient care report (PCR) with the hospital staff, you should not add information to the front of the report. If you discover that you forgot to include vital patient information, you should document the information on a separate

addendum and furnish it to the emergency department; this document can be sent by fax. The copy of your PCR you leave at the hospital and the original PCR should contain the same information; adding information to the front of the PCR after leaving a copy at the hospital makes the copy and the original two separate documents. In which of the following situations would the EMT MOST likely deliver a baby at the scene? - 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. As you begin ventilating an unresponsive apneic man, you hear gurgling in his upper airway. Your MOST immediate action should be to: - 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! Ten days after treating a 34-year-old patient with tuberculosis, you are given a tuberculin skin test, which yields a positive result. This MOST likely indicates that: - you were exposed to another infected person prior to treating the 34-year-old patient. When assessing a patient with a medical complaint, which of the following would MOST likely reveal the cause of the problem? - Medical history When caring for a patient with an altered mental status and signs of circulatory compromise, you should: - limit your time at the scene to 10 minutes or less, if possible. An infectious disease is MOST accurately defined as: - a medical condition caused by the growth and spread of small, harmful organisms within the body. Hepatitis B is more virulent than hepatitis C, which means that it: - has a greater ability to produce disease. You and your EMT partner arrive at the residence of a 50-year-old man who complains of weakness. Your primary assessment reveals that he is critically ill and will require aggressive treatment. The closest hospital is 25 miles away. You should: - manage all threats to airway, breathing, and circulation and consider requesting an ALS unit.

The BEST way to prevent infection from whooping cough is to: - get vaccinated against diphtheria, tetanus, and pertussis. A 59-year-old male with a history of emphysema complains of an acute worsening of his dyspnea and pleuritic chest pain following a forceful cough. Your assessment reveals that he has a barrel-shaped chest, unilaterally diminished breath sounds, and tachycardia. What is the MOST likely cause of this patient's condition? - Spontaneous pneumothoraxA pleural effusion is MOST accurately defined as: A pleural effusion is MOST accurately defined as: - fluid accumulation outside the lung. Asthma is caused by a response of the: - immune system. His parents tell you that their son has had a chest infection for the past two days and when they took him to their family doctor, they were told it was likely due to the respiratory syncytial virus (RSV). They have kept him well hydrated, but the infection seems to have gotten worse. On auscultation, you hear decreased air entry bilaterally with fine expiratory wheezes and the occasional coarse wet crackle. Based on this information, your patient is most likely suffering from: - bronchiolitis. A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should: - assess the adequacy of his respirations. A dissecting aortic aneurysm occurs when: - the inner layers of the aorta become separated. The electrical impulse generated by the heart originates in the: - sinoatrial node. The EMT should use an AED on a child between 1 month and 8 years of age if: - pediatric pads and an energy-reducing device are available. Which of the following signs is commonly observed in patients with right-sided heart failure? - Dependent edema