Paramedic Final

You have been on the scene of a 55-year-old cardiac arrest patient for 30 minutes. You have full ALS care initiated, with no response to therapy. You should:

consider termination of the arrest.

A 30-year-old woman has right-sided abdominal pain and is hypotensive. You suspect she may have a ruptured ectopic pregnancy. You recognize:

life-threatening hemorrhagic shock and the need for fluid resuscitation.

Your patient is a 24-year-old male Chinese citizen on vacation in the United States. He is in moderate distress, complaining of difficulty breathing and gives a four-day history of runny nose, sore throat, fever, chills, and general malaise with a productive cough. His sputum production was significantly worse when he woke this morning, and he developed difficulty breathing this afternoon. HR = 134, BP = 132/84, RR = 26, SaO2 = 90%. This presentation is most consistent with:

SARS.

You are on the scene of a call for an injured woman. Your scene size-up did not reveal any indications of danger. On assessing the patient, she tells you that she was beaten with a telephone receiver by her estranged husband. Before you can request law enforcement assistance, the husband returns with a baseball bat and threatens to kill you if you don't leave the house and states, "She's staying here," in reference to the patient. The assailant is standing with the bat held above his shoulder, ready to swing. Which of the following is the best course of action?

Retreat from the residence, leaving the patient behind; move your vehicle away from the address; and request law enforcement.

Which of the following is a manifestation of orthostatic hypotension?

Your patient's blood pressure is 142/90 when she is supine but 116/88 when she sits up.

Which of the following is TRUE if the ground transport time is equal to air medical transport time?

The patient should be transported by ground, as it is safer for the patient and crew.

Ventilation is:

the mechanical process of moving air in and out of the lungs.

A patient with COPD should present with a PO2 of:

50-60 mmHg.

You are caring for a 42-year-old woman who is 32 weeks pregnant with twins. She is complaining of a severe headache and blurred vision, and lives in a rural area approximately 30 miles from the nearest ED. Your physical exam reveals significant peripheral edema and the following vital signs: heart rate 98, blood pressure 156/98 mmHg, respirations 18. The patient states she has a history of hypertension, but has not taken her prescribed medications because "they aren't safe for the babies." Appropriate treatment for this patient includes:

intravenous magnesium sulfate and rapid transport.

You are driving with lights and siren to an emergency call. As you approach a busy intersection, you see that the light is red and there are cars stopped in all lanes of traffic. You should:

sound the horn as you approach, wait for the light to turn, and then proceed with lights and siren.

Managing a laceration with arterial bleeding most often requires:

direct pressure

Which of the following factors may lead to injury or death of EMS personnel attempting water rescue?

All of the above

An area of burned tissue that is not painful is MOST likely a ________ burn injury.

full thickness

When assessing a patient with a crush injury, which of the following findings would indicate that toxins have entered the central circulation?

Cardiac arrhythmia

Your patient is a 23-year-old man with a gunshot wound to the abdomen and an exit wound in the right flank. He responds to verbal stimuli; has pale, cool, diaphoretic skin; and has a heart rate of 128, respirations at 24, and a blood pressure of 82/60. These findings indicate which of the following kind of shock?

Decompensated

The most important determinant of ventilatory rate is:

arterial PCO2.

Upon examining your patient, you note that he has a clubbing of the fingers. You would suspect a history of:

hypoxemia.

Which of the following is the sequence of actions in water rescue?

Reach, throw, row, go

A 64-year-old female is alert and oriented, in moderate respiratory distress, and complaining of chest pain. She describes an acute onset of right-sided chest pain that radiates across her chest. Physical examination reveals cold, diaphoretic skin; lung sounds with crackles bilaterally; JVD; and peripheral edema. Medical history includes hypertension, prior myocardial infarction, and heart failure. HR = 128, BP = 86/56, RR = 26, SaO2 = 92%. Which of the following is appropriate in the prehospital treatment of this patient?

Dopamine

You run a 12-lead ECG on a patient exhibiting chest pain. It reveals ST segment elevation in leads II, III, and aVF, with reciprocal in leads aVL and I. You suspect:

inferior MI.

Your patient is a four-year-old boy with a history of asthma. He ran out of his inhaled bronchodilator while visiting his grandparents' farm. The patient has pale, cool, moist skin with cyanosis of his nail beds. He has audible wheezing with a respiratory rate of 18, accessory muscle use, and a heart rate of 130. He appears fatigued, he is unable to speak more than one or two words at a time, and his head bobs with each breath. Which of the following best describes this patient's respiratory status?

A) Because of decreased respiratory, cardiovascular, and stored energy reserves, the child's muscles have fatigued and he is now in respiratory failure.

Which of the following findings indicates a progression from compensated shock to decompensated shock?

Altered mental status

One small box on the ECG paper indicates:

0.04 seconds.

You are assessing your respiratory patient. Of the following findings, which would concern you the most?

Altered mental status

Paradoxical movement is associated with:

flail chest.

Ventricular repolarization is represented on the ECG by the:

T wave

Which of the following provides evidence that a patient is using accessory muscles to breathe?

There is noticeable contraction of the intercostal muscles.

You are transporting a cardiac arrest when you achieve ROSC. You now want to keep the patient's systolic blood pressure in the range of:

80-100 mmHg.

Which of the following is the ideal size of a helicopter landing zone during daytime conditions?

100 square ft

Obstructive sleep apnea is an example of:

upper airway obstruction.

You are called to a patient with severe shortness of breath. Upon arrival, you find your patient in the tripod position, with pursed lips and audible wheezing. SpO2 is at 89% and capnography shows a "shark fin" pattern with an ETCO2 of 50. You should:

administer a beta agonist.

Your patient is a 24-year-old male who has been an in-patient in a rehabilitation hospital following surgical fixation of a fractured pelvis. Staff reports sudden development of hypotension and severe respiratory distress about 30 minutes ago. There is no other significant history. Physical exam findings include cold, diaphoretic skin with peripheral cyanosis; jugular venous distension; clear breath sounds bilaterally; and vitals as follows: HR = 134, BP = 74/50, RR = 28, SaO2 = 84%. Which of the following is most likely?

Pulmonary embolism

Your patient is a 52-year-old male complaining of shortness of breath. He is sitting up, alert, and oriented and appears to be in moderate respiratory distress. He states that he "always gets a chest cold in the winter" and describes a three-week history of productive cough and increasing shortness of breath. Physical examination reveals coarse rhonchi to the upper lobes bilaterally, air movement is decreased in the bases, and his skin is cool with peripheral cyanosis. You note that he is overweight and describes an 18-pack-a-year smoking history. Based on these clinical exam findings, the most clinically relevant finding you might also expect is:

JVD, ankle edema, and hepatic congestion.

Your patient is a 30-year-old pregnant woman at 36 weeks' gestation. She was injured in a fall from a horse and is complaining of painful contractions. Her abdomen is tender to palpation over the uterus, and the uterus becomes firm with contractions, but she denies vaginal bleeding. The patient is anxious, but her skin is warm and dry. Her blood pressure is 112/70, her heart rate is 92, and her respirations are 24. Which of the following statements best describes this situation?

The mechanism and patient complaints are suspicious for abruptio placentae. Both the mother and the fetus are in jeopardy.

Your patient is a 60-year-old female restrained driver involved in a moderate-speed frontal impact collision. When you arrive at the scene, she is sitting up in the driver's seat with a chief complaint of a burning sensation in her face. You note abrasions from deployment of the airbag. After immobilizing the patient on a long backboard, you begin transport. As you perform a detailed examination, the patient complains of developing right shoulder pain. Which of the following should you suspect?

Intraabdominal bleeding

On approaching a vehicle that has crashed into a retaining wall and in which the driver appears to be entrapped, you should do which of the following?

Stabilize the vehicle.

The five-step procedure for analyzing ECGs includes all of the following EXCEPT:

V1.

A 22-year-old woman presents with left-sided lower abdominal pain. She reports that her last menstrual cycle ended approximately 10 days ago. Her blood pressure is normal and she rates the pain as 6 on a scale of 10. You should:

palpate the abdomen.

Your patient is a five-year-old girl who awoke with a harsh cough, sore throat, drooling, and high fever. She has shallow respirations of 40 and inspiratory stridor. She is completely focused on breathing, leaning forward on her outstretched arms. Which of the following is the best course of action?

Provide blow-by oxygen, humidified if possible; transport without delay and avoid procedures that might upset her.

A 37-year-old, obviously pregnant woman complains of sharp, tearing abdominal pain. She reports that she is pregnant with her fifth child, but states she cannot remember the exact due date. The patient has a history of drug use and states that she last smoked crack cocaine approximately 30 minutes ago. You suspect:

abruptio placentae.

At the scene of a potential hazmat incident, where should the ambulance be parked?

Uphill and upwind

A newborn has just been delivered. He is centrally pink with pale extremities, has a heart rate of 110, and is actively crying and moving. The appropriate APGAR score for this infant is:

9.

A sudden disruption of pulmonary perfusion caused by a blood clot is known as:

pulmonary embolism

You are caring for a seven-year-old in ventricular fibrillation. The child weighs 19 kg. You have just delivered your first shock, and another paramedic reports that she has obtained IO access. You should direct the paramedic to administer what dose of epinephrine?

0.19 mg of 1:10,000

Your patient is a 68-year-old male complaining of difficulty breathing for two days. He is sitting up, conscious, alert, and oriented and appears to be in mild respiratory distress. Physical examination reveals cool, dry, pink skin; he is thin with well-defined accessory muscles, and you note diffuse wheezing to all lung fields. HR = 102, BP = 136/96, RR = 20, SaO2 = 92%. The patient gives a 20-pack-a-year history of smoking. These findings are most typical of:

emphysema.

Your patient is a 27-year-old man with one stab wound at the fifth intercostal space posteriorly, on the right. He is ambulatory at the scene, but dyspneic and has air movement at the site of the injury. Which of the following should you do first?

Prepare an occlusive dressing.

Which of the following findings differentiates a simple pneumothorax from a tension pneumothorax?

Hemodynamic compromise

You have been dispatched to a call for a burn patient. Upon arriving, you find a 23-year-old woman who was sunbathing and fell asleep. She is alert and oriented and in moderate pain. She has blisters covering her extremities, abdomen, face, and chest. This patient's burns fall into which one of the following categories?

Critical

An early sign of hyperkalemia is:

tall, peaked T waves on an ECG.

Cardiac muscle is different from smooth muscle in the fact that it has:

automaticity.

You are assessing a 37-year-old woman who was rescued from an apartment fire. She has a harsh, stridorous, "brassy"-sounding cough productive of sooty sputum. Her eyebrows and the hair around her face are singed. Respirations = 28, heart rate = 108, and blood pressure = 124/84. You have a 30-minute transport time. Which of the following is the best intervention for this patient?

Rapid sequence intubation and endotracheal intubation

Which of the following BEST describes why paramedics should be trained to an awareness level regarding rescue operations?

Awareness training enables paramedics to recognize the need for more resources.

Your patient is a 75-year-old woman who is complaining of generalized weakness and loss of appetite. Your physical exam reveals no remarkable findings, and the patient has no significant past medical history. You reassure the patient that these are common complaints among people in her age group. Which of the following should you do next?

Transport the patient for evaluation of a potentially serious medical problem.

A 22-year-old woman presents with severe abdominal pain and signs of shock. When asked whether she is pregnant, she states, "There's no way I'm pregnant, I have an IUD." Which of the following is the most likely cause of her signs and symptoms?

Ectopic pregnancy

You are caring for a patient injured in a back-country fall. You have accessed the patient and packaged him for transport and are awaiting the arrival of a helicopter. Knowing that the patient is 30 to 40 minutes from the nearest hospital by air, which of the following should you consider?

Administering pain medication and wrapping the patient in blankets

Which of the following structures FIRST allows gas exchange as air enters the lungs?

Respiratory bronchioles

You have arrived on the scene of a paramedic who was shot as she approached a residence on a call. The scene has since been secured. Your patient is a 38-year-old woman with one gunshot wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and difficulty breathing. The patient's EMT partner has applied oxygen by nonrebreather mask and placed an occlusive dressing over the entry wound before your arrival. As you continue your assessment, the patient's level of consciousness decreases. She responds to verbal stimuli. Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side. The patient lacks a radial pulse, and her abdomen is non-guarded and non-tender. Which of the following best explains th

Hemothorax

As you approach the scene of a motor vehicle collision, you realize that there is a tanker truck involved and that it has tipped over. Which of the following actions is appropriate?

Stop a safe distance away, use binoculars to locate any placards on the tanker, and reference the Emergency Response Guide.

A 38-year-old pregnant woman called 911 after she developed a "splitting headache" unrelieved by over-the-counter analgesics. She states that she has a previous diagnosis of diabetes that is typically well controlled with insulin injections. This patient's history of diabetes makes her more likely to develop which of the following pregnancy-related conditions?

Preeclampsia

During which phase of a burn injury does extravasation of proteins, water, and electrolytes occur, resulting in edema and potential hypovolemia?

Fluid shift

Which of the following is NOT part of the respiratory status assessment?

Lung compliance

Normal interval time for the QRS complex is:

0.04-0.12 second.

Your patient is a 45-year-old man who has received several stab wounds to the chest and abdomen. Although bleeding was significant at first, the rate of bleeding had slowed considerably before your arrival. The patient is agitated and confused, pale, diaphoretic, and cool to the touch. He lacks a radial pulse, and his carotid pulse is weak and rapid. Respirations are 28 and shallow. Which of the following is certain with this patient?

He is in decompensated shock.

Your patient is a 58-year-old female who is confused and dyspneic. Her daughter called EMS because the patient complained of a fluttering sensation in her chest, followed a few minutes later by chest pain and an acute onset of confusion. She is pale and diaphoretic without a palpable radial pulse. The monitor shows a narrow complex rhythm at a rate of 180. Which of the following is most appropriate?

Immediate synchronized cardioversion

Your patient is a 13 year-old male drowning victim. He was initially in cardiac arrest with a pulseless, wide-complex bradycardia. He is intubated and being ventilated with supplemental oxygen. After CPR and intubation, the patient is now in ventricular tachycardia with a weak radial pulse. Which of the following would be an appropriate treatment for this patient?

Synchronized cardioversion starting at 0.5-1.0 joules/kg

A 27-year-old pregnant woman was the restrained driver of a vehicle that hit the guardrail at a high rate of speed. She sustained a large laceration to the upper thigh and has lost a significant amount of blood. Vital signs are: heart rate 102, blood pressure 118/78 mmHg, respirations 18, and her skin is pale and clammy. Which of the following BEST explains this patient's presentation?

Maternal blood volume increases during pregnancy, allowing vital signs to remain normal despite significant blood loss.

All the following are seen in Cushing's triad, EXCEPT:

tachycardia.

You are caring for an elderly patient who lives alone. The patient is complaining of feeling unwell for a period of several days and seems to be unable to provide a detailed personal medical history. An appropriate assessment of this patient should include:

an assessment of living conditions, nutrition, and social support.

People in which of the following age groups are prone to significant trauma due to falls?

Geriatric population

Penetrating trauma to the face can complicate airway management by which of the following mechanisms?

Both B and C

Diaphoresis exhibited in a patient actively having an MI is due to:

sympathetic response.

Which of the following is TRUE of asthma in the pediatric patient?

Oxygen and nebulized beta agonists are indicated in the initial phase of an asthma attack.

Which of the following patients would NOT be a candidate for transport via fixed-wing aircraft?

32-year-old man requiring prolonged extrication following a vehicle accident

Your patient is a 72-year-old female, alert and oriented, sitting up in bed at a nursing home. She is in mild respiratory distress. The staff describes a four-day history of fever, malaise, and productive cough. The patient also states that she has been experiencing chills and chest pain with deep inspiration. Physical examination reveals rales and rhonchi in the right upper lobe and warm, moist skin. HR = 116, BP = 104/76, RR = 20, SaO2 = 93%. Based on the clinical exam findings, the most appropriate diagnosis would be:

pneumonia.

Which of the following is the highest priority when managing a patient with bilateral closed femur fractures?

Anticipating hypovolemia

During which phase of the cardiac cycle does ventricular filling begin?

Diastole

An elevation of the ST segment is associated with:

myocardial injury

A 24-year-old pregnant woman is actively seizing. Her partner reports that she complained of abdominal pain approximately 10 minutes ago, and then began seizing. He reports that the seizure activity has been consistent for the past 10 minutes, and that she has no significant medical history. You should:

apply high-flow oxygen, administer magnesium sulfate, and transport emergently.

You are caring for a patient with 30 percent full and partial thickness burns. He is an 80 kg man. According to the Parkland formula, he should receive ________ liters of fluid over 24 hours, with ________ liters infused in the first 8 hours.

9.6; 4.8

You have just delivered an infant at 33 weeks gestation. The infant is blue and limp and has a brachial pulse of 70 beats per minute. What is the appropriate sequence of care for this infant?

Keep warm and dry, clamp and cut the cord, positive pressure ventilations.

Most collisions involving ambulances occur:

at intersections.

The intrinsic rate of the SA node is:

60-100 bpm.

Your patient is a five-year-old boy who appears to be dehydrated after having the flu. Which of the following is the best way to communicate with the patient regarding the need for obtaining IV access?

Tell him you need to give him fluids to help him feel better and that it might hurt a little when you start the IV.

Treatment of sinus tachycardia is aimed at:

treating the underlying cause.

Which of the following actions of the paramedic may lead to decubitus ulcer development in the elderly patient?

All of the above

Normal interval time for the PR interval is:

0.12-0.20 second.

A newborn is listless and has a heart rate of 50 beats per minute after 30 seconds of stimulation. You should FIRST:

initiate positive pressure ventilation.

You are called to care for a patient with severe shortness of breath. The patient has an SpO2 of 88%, audible wheezing, and a capnography reading of 54 with a shark fin wave form. You are administering albuterol for the second time without relief. You suspect:

status asthmaticus.

Which of the following parameters should be used to guide the oxygenation and ventilation of the patient with a traumatic brain injury?

Maintain an oxygen saturation level of at least 96 percent and a capnography reading between 35 and 40 mmHg.

Your patient is a 38-year-old man who was pinned beneath the frame of a vehicle when it slipped off the makeshift jacks he was using to elevate it. The patient's brother thinks he may have been trapped for up to 20 minutes. The rescue unit is preparing to use airbags to lift the vehicle off the patient. Which of the following medications could you consider giving this patient?

Sodium bicarbonate

Which of the following best describes the concept of due regard?

The higher standard of safety that guides the operation of emergency vehicles

Which of the following best describes "peak load"?

The highest volume of calls at a given time

A 12-lead ECG that reveals slight ST segment elevation; Q waves in leads II, III, and aVF; and ST elevation in V1 and V2 most indicate which of the following?

The patient has had a myocardial infarction in her inferior wall and is experiencing ischemia extending into the right ventricle.

Your patient is an 82-year-old woman whose daughter called EMS because the patient became very short of breath as they walked from their parking spot to the front of their church. On your arrival, the patient states that she just needed a little rest and now feels much better. On questioning, she admits to several such episodes in the past month. She denies chest pain and she says, "I just got winded because I'm getting so old." The patient has a heart rate of 104, a respiratory rate of 20, and blood pressure of 172/90 mmHg. Your history and physical examination should focus on which of the following possibilities?

Myocardial infarction

The average adult tidal volume is:

500 mL

You are delayed getting to a residence where a 16-month-old boy is actively seizing. The mother reports that he has had a fever for the past two days. A firefighter on scene informs you that the child has been seizing since their arrival approximately 15 minutes ago. You should:

apply oxygen, administer intranasal midazolam, and transport.

The son of a 73-year-old woman has called 911. The patient is confused and exhibiting out-of-character behavior. The son informs you that she is a diabetic, and takes pills and not injectable insulin. Assessment reveals adequate breathing, skin that is cool, and a radial pulse that is rapid and weak. Based on this history, you should be suspicious of:

hyperglycemia.

Which of the following is a complication of positive-pressure ventilation in the patient with significant chest trauma?

Impaired venous return to the heart

A 20-year-old sexually active woman presents with severe right-side abdominal pain that radiates to her back. She states that the pain came on sharply during intercourse about 15 minutes earlier, and she reports a small amount of vaginal bleeding. She states that her menstrual cycles have been irregular for the past 3 months. The most likely clinical diagnosis would be:

ruptured ovarian cyst.

A patient with known arteriosclerosis was outside doing lawn work when he started experiencing chest pain. Upon your arrival, the patient states that he has been resting and took a prescribed nitroglycerin tablet 5 minutes ago. The patient states that the pain is subsiding. You suspect:

stable angina.