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ABEM EMS practice questions

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Question 1Clinical EMS and Out-of-Hospital Emergency Care

A 58-year-old man collapses in ventricular fibrillation. After the first defibrillation attempt, CPR is resumed. According to current advanced cardiac life support guidance, when should the next rhythm check occur?

  1. After 2 minutes of uninterrupted chest compressions Correct answer.
  2. Immediately after the shock is delivered
  3. Only after epinephrine is administered
  4. After 30 seconds of compressions

Explanation

After a shock, compressions are resumed immediately and continued for a full 2-minute cycle before the next rhythm check. Interrupting compressions earlier reduces coronary perfusion and survival.

Question 2Clinical EMS and Out-of-Hospital Emergency Care

Which finding best supports the prehospital diagnosis of tension pneumothorax in a hypotensive trauma patient?

  1. Fine crackles at both lung bases
  2. Tracheal deviation toward the affected side
  3. Subcutaneous emphysema confined to the neck
  4. Severe respiratory distress with absent breath sounds and hypotension on the affected side Correct answer.

Explanation

Tension pneumothorax produces unilateral absent breath sounds, severe distress, and hemodynamic compromise from impaired venous return. Treatment is emergent decompression without waiting for imaging.

Question 3Clinical EMS and Out-of-Hospital Emergency Care

A patient with severe asthma is in status asthmaticus with minimal air movement and rising PaCO2. Which change in the clinical picture is most concerning?

  1. Persistent expiratory wheezing
  2. A quiet chest with diminishing breath sounds Correct answer.
  3. Use of accessory muscles
  4. A respiratory rate of 28 breaths/min

Explanation

A silent or quiet chest in a patient who was previously wheezing signals critically low airflow and impending respiratory failure. Rising PaCO2 in this setting reflects fatigue rather than improvement.

Question 4Clinical EMS and Out-of-Hospital Emergency Care

In an adult with suspected opioid overdose and respiratory depression, which intervention has the highest immediate priority?

  1. Obtaining a 12-lead ECG
  2. Administration of naloxone
  3. Bag-mask ventilation and airway support Correct answer.
  4. Establishing intravenous access

Explanation

The immediate threat to life in opioid overdose is hypoventilation and hypoxia. Ventilation and airway support take priority, with naloxone given to restore spontaneous breathing.

Question 5Clinical EMS and Out-of-Hospital Emergency Care

A 70-kg adult in cardiac arrest receives epinephrine during ACLS. What is the standard initial intravenous dose?

  1. 3 mg
  2. 0.1 mg
  3. 1 mg Correct answer.
  4. 0.5 mg

Explanation

The standard ACLS dose of epinephrine for adult cardiac arrest is 1 mg IV/IO every 3 to 5 minutes. Higher doses are not recommended for routine use.

Question 6Clinical EMS and Out-of-Hospital Emergency Care

A trauma patient is hypotensive with a suspected pelvic fracture. Which maneuver is most appropriate for initial hemorrhage control?

  1. Manual traction of the lower extremities
  2. Log-rolling the patient onto the side
  3. Elevation of the head of the stretcher
  4. Application of a pelvic binder at the level of the greater trochanters Correct answer.

Explanation

A pelvic binder placed at the level of the greater trochanters stabilizes the pelvis and reduces intrapelvic volume and bleeding. Early application improves hemodynamics in unstable pelvic fractures.

Question 7Clinical EMS and Out-of-Hospital Emergency Care

Which sign most reliably distinguishes an absence seizure from a simple partial seizure?

  1. Brief impairment of consciousness with staring Correct answer.
  2. Postictal confusion lasting hours
  3. An aura preceding the event
  4. Unilateral motor jerking

Explanation

Absence seizures are characterized by brief staring spells with impaired awareness and no postictal phase. Focal motor features and auras point toward partial seizures.

Question 8Clinical EMS and Out-of-Hospital Emergency Care

A patient with a suspected acute ischemic stroke has a last known well time of 2 hours ago. Which prehospital action most directly affects eligibility for reperfusion therapy?

  1. Rapid identification and transport to a stroke-capable facility Correct answer.
  2. Obtaining a fingerstick glucose only at the hospital
  3. Administering aspirin en route
  4. Lowering the blood pressure aggressively

Explanation

Time-dependent reperfusion therapy depends on rapid recognition and transport to a facility capable of thrombolysis or thrombectomy. Prehospital stroke scales and routing shorten door-to-treatment intervals.

Question 9Clinical EMS and Out-of-Hospital Emergency Care

Which finding is most characteristic of anaphylaxis rather than a simple allergic reaction?

  1. Localized urticaria at the sting site
  2. Isolated itching without other symptoms
  3. Mild nasal congestion
  4. Hypotension with respiratory compromise Correct answer.

Explanation

Anaphylaxis involves multiple organ systems or hemodynamic compromise, such as hypotension or airway swelling. Localized skin findings alone do not meet the criteria.

Question 10Clinical EMS and Out-of-Hospital Emergency Care

A patient with severe diabetic ketoacidosis is being transported. Which prehospital intervention is most important?

  1. Rapid correction of glucose with high-dose insulin
  2. Aggressive normal saline resuscitation with monitoring for hypoglycemia Correct answer.
  3. Administration of oral bicarbonate
  4. Immediate potassium supplementation without labs

Explanation

Initial management of DKA centers on fluid resuscitation with isotonic crystalloid and close glucose monitoring. Insulin and potassium adjustments require laboratory guidance.

Question 11Clinical EMS and Out-of-Hospital Emergency Care

Which of the following findings most strongly suggests a basilar skull fracture?

  1. A single episode of epistaxis
  2. Clear fluid draining from the nose with a positive halo sign Correct answer.
  3. Bilateral periorbital ecchymosis after minor trauma
  4. Tenderness over the mastoid after a direct blow

Explanation

Clear rhinorrhea with a positive halo sign suggests cerebrospinal fluid leak from an anterior basilar skull fracture. Avoidance of nasal tubes is important in this setting.

Question 12Clinical EMS and Out-of-Hospital Emergency Care

A child presents with drooling, tripod positioning, and high fever with muffled voice. Which intervention is most appropriate?

  1. Administering oral antibiotics immediately
  2. Keeping the child calm and transporting urgently with airway equipment ready Correct answer.
  3. Inspecting the posterior pharynx with a tongue blade
  4. Placing the child supine for a full assessment

Explanation

These findings suggest epiglottitis, a potential airway emergency. Agitating the child or instrumenting the airway can precipitate complete obstruction.

Question 13Clinical EMS and Out-of-Hospital Emergency Care

Which statement about the use of tourniquets for extremity hemorrhage is correct?

  1. A tourniquet is applied proximal to the wound and tightened until bleeding stops Correct answer.
  2. Tourniquets are contraindicated in military or civilian settings
  3. Tourniquets should be loosened every 5 minutes to allow perfusion
  4. Direct pressure should never be used before a tourniquet

Explanation

A tourniquet is placed proximal to the bleeding site and tightened until hemorrhage is controlled. Once applied, it is generally left in place until definitive care.

Question 14Clinical EMS and Out-of-Hospital Emergency Care

A patient with a suspected cervical spine injury must be moved due to an unsafe scene. Which technique best maintains spinal alignment?

  1. Having the patient sit upright and walk
  2. Rapid extrication with manual in-line stabilization Correct answer.
  3. Rolling the patient prone before lifting
  4. Dragging the patient by the shoulders

Explanation

When urgent movement is required, manual in-line stabilization during a coordinated rapid extrication minimizes spinal motion. Spinal motion restriction is maintained throughout.

Question 15Clinical EMS and Out-of-Hospital Emergency Care

Which vital sign abnormality is most consistent with neurogenic shock after a high cervical spinal cord injury?

  1. Hypotension with tachycardia and cool skin
  2. Hypertension with tachycardia and diaphoresis
  3. Hypotension with bradycardia and warm skin Correct answer.
  4. Hypertension with bradycardia

Explanation

Neurogenic shock results from loss of sympathetic tone, producing hypotension, bradycardia, and warm, dry skin. Hemorrhagic shock, by contrast, typically causes tachycardia and cool skin.

Question 16Clinical EMS and Out-of-Hospital Emergency Care

A patient is in pulseless ventricular tachycardia. Which intervention is indicated first?

  1. Transcutaneous pacing
  2. Immediate defibrillation Correct answer.
  3. Administration of atropine
  4. Synchronized cardioversion

Explanation

Pulseless ventricular tachycardia is treated as a shockable cardiac arrest rhythm with immediate defibrillation and CPR. Synchronized cardioversion applies only to patients with a pulse.

Question 17Clinical EMS and Out-of-Hospital Emergency Care

A patient with a suspected opioid overdose has been given naloxone and now has adequate respirations. What is the most important next consideration?

  1. Withhold oxygen to assess response
  2. Administer a second dose regardless of response
  3. Discharge the patient if alert
  4. Monitor for recurrent respiratory depression because naloxone may wear off before the opioid Correct answer.

Explanation

Naloxone has a shorter duration than many opioids, so respiratory depression can recur. Continued monitoring and transport are essential after an initial response.

Question 18Clinical EMS and Out-of-Hospital Emergency Care

Which of the following best describes the purpose of the START triage method?

  1. To decide the destination hospital for each patient
  2. To assign treatment priorities rapidly during a mass-casualty incident Correct answer.
  3. To determine the dose of analgesia for trauma patients
  4. To calculate the Glasgow Coma Scale score

Explanation

START is a rapid triage system that sorts casualties into immediate, delayed, minor, and deceased categories based on respirations, perfusion, and mental status. It is not a treatment or destination tool.

Question 19Clinical EMS and Out-of-Hospital Emergency Care

A patient with severe hypothermia in cardiac arrest is being transported. Which statement about resuscitation is most accurate?

  1. Defibrillation should be attempted only once before rewarming
  2. Rewarming and prolonged resuscitation may be appropriate because hypothermic arrest can be reversible Correct answer.
  3. Resuscitation should be terminated immediately
  4. Warm intravenous fluids are contraindicated

Explanation

Severe hypothermia can depress myocardial function and produce apparent arrest that may reverse with rewarming. Prolonged resuscitation and gentle handling are appropriate in this setting.

Question 20Clinical EMS and Out-of-Hospital Emergency Care

Which finding is most consistent with a simple partial seizure?

  1. Focal motor activity with preserved awareness Correct answer.
  2. Generalized tonic-clonic activity with loss of consciousness
  3. Brief staring with immediate recovery
  4. Postictal confusion lasting hours after a staring spell

Explanation

Simple partial seizures produce focal symptoms without impairment of consciousness. Complex partial seizures involve altered awareness.

Question 21Clinical EMS and Out-of-Hospital Emergency Care

A patient with a suspected acute myocardial infarction reports chest pain. Which prehospital medication has been shown to reduce mortality when given early?

  1. Intravenous furosemide
  2. Sublingual nitroglycerin
  3. Aspirin Correct answer.
  4. Oral beta-blocker

Explanation

Early aspirin reduces mortality in acute myocardial infarction by inhibiting platelet aggregation. Nitroglycerin relieves symptoms but has not been shown to reduce mortality.

Question 22Clinical EMS and Out-of-Hospital Emergency Care

A patient with a suspected tension pneumothorax is deteriorating. Which intervention is most appropriate when needle decompression is indicated?

  1. Insertion of a needle at the sixth intercostal space in the midaxillary line
  2. Insertion of a large-bore needle in the second intercostal space at the midclavicular line Correct answer.
  3. Administration of high-flow oxygen alone
  4. Observation until hospital arrival

Explanation

Needle decompression is performed in the second intercostal space at the midclavicular line or the fourth to fifth intercostal space at the anterior axillary line. It is indicated for hemodynamic instability.

Question 23Clinical EMS and Out-of-Hospital Emergency Care

Which of the following is a contraindication to the use of nitroglycerin in a patient with chest pain?

  1. Recent use of a phosphodiesterase inhibitor for erectile dysfunction Correct answer.
  2. A history of hypertension
  3. Mild nausea
  4. Age over 65 years

Explanation

Concurrent use of phosphodiesterase inhibitors can cause profound hypotension with nitroglycerin. Other contraindications include hypotension and right ventricular infarction.

Question 24Clinical EMS and Out-of-Hospital Emergency Care

A child with a suspected foreign body airway obstruction is coughing forcefully and making sounds. What is the most appropriate action?

  1. Administer back blows while the child is supine
  2. Begin blind finger sweeps
  3. Perform abdominal thrusts immediately
  4. Encourage coughing and monitor Correct answer.

Explanation

An effective cough indicates the airway is partially patent and the child can move air. Interventions such as thrusts are reserved for ineffective cough or impending obstruction.

Question 25Clinical EMS and Out-of-Hospital Emergency Care

Which statement best describes the role of the prehospital 12-lead ECG in suspected acute coronary syndrome?

  1. It reliably excludes myocardial infarction when normal
  2. It can identify ST-elevation and activate early reperfusion pathways Correct answer.
  3. It is useful only after hospital arrival
  4. It replaces the need for hospital-based reperfusion decisions

Explanation

Prehospital 12-lead ECG identifies ST-elevation and allows early activation of catheterization or fibrinolysis pathways. A normal ECG does not exclude infarction.

Question 26Clinical EMS and Out-of-Hospital Emergency Care

A 45-year-old man is in cardiac arrest with ventricular fibrillation. After one shock and two minutes of CPR, the rhythm remains ventricular fibrillation. Which medication should be administered next?

  1. Sodium bicarbonate 1 mEq/kg IV push
  2. Amiodarone 300 mg IV push Correct answer.
  3. Atropine 1 mg IV push
  4. Epinephrine 1 mg IV push

Explanation

For shock-refractory ventricular fibrillation, amiodarone is recommended after the second shock. Epinephrine is given after the first shock but before the second shock in the cardiac arrest algorithm. Atropine is not indicated for ventricular fibrillation.

Question 27Clinical EMS and Out-of-Hospital Emergency Care

A 30-year-old woman is found unresponsive with a suspected opioid overdose and a respiratory rate of 4 breaths/min. After administering naloxone, her respirations improve. What is the most appropriate next action?

  1. Place her in a prone position
  2. Discharge her from care
  3. Administer a second dose of naloxone immediately
  4. Perform a thorough reassessment and monitor for recurrence Correct answer.

Explanation

After naloxone improves respirations, the patient requires continued monitoring because the opioid may outlast naloxone, leading to recurrent respiratory depression. Reassessment includes vital signs and mental status. Immediate additional naloxone is not indicated if respirations are adequate.

Question 28Clinical EMS and Out-of-Hospital Emergency Care

A 55-year-old man with chest pain has a blood pressure of 88/50 mm Hg and a heart rate of 110 beats/min. Which prehospital intervention is contraindicated?

  1. Applying supplemental oxygen
  2. Administering aspirin
  3. Obtaining a 12-lead ECG
  4. Administering nitroglycerin Correct answer.

Explanation

Nitroglycerin is contraindicated in hypotension because it can further reduce blood pressure through venodilation. Aspirin, oxygen, and ECG acquisition are appropriate in suspected acute coronary syndrome.

Question 29Clinical EMS and Out-of-Hospital Emergency Care

A 60-year-old woman with a history of COPD presents with sudden-onset severe dyspnea and absent breath sounds on the right side. Which condition is most likely?

  1. Acute bronchitis
  2. Pneumonia
  3. Pulmonary embolism
  4. Pneumothorax Correct answer.

Explanation

Sudden dyspnea with unilateral absent breath sounds suggests a pneumothorax. Pulmonary embolism typically presents with dyspnea and pleuritic pain but usually has bilateral breath sounds. Bronchitis and pneumonia do not typically cause absent breath sounds on one side.

Question 30Clinical EMS and Out-of-Hospital Emergency Care

A 25-year-old man is experiencing a severe asthma attack. He is speaking in short phrases, has a respiratory rate of 32 breaths/min, and an oxygen saturation of 88% on room air. Which initial treatment is most appropriate?

  1. Administering a diuretic intravenously
  2. Administering a beta-agonist via nebulizer Correct answer.
  3. Administering a corticosteroid orally
  4. Administering epinephrine intramuscularly

Explanation

The first-line treatment for severe asthma exacerbation is a short-acting beta-agonist by nebulizer or metered-dose inhaler. Systemic corticosteroids are also given but are not the initial bronchodilator. Epinephrine is reserved for anaphylaxis or severe cases unresponsive to initial therapy.

Question 31Clinical EMS and Out-of-Hospital Emergency Care

A 70-year-old man is found unresponsive with a blood glucose of 40 mg/dL. After administering oral glucose, he remains unresponsive. What is the next appropriate action?

  1. Administer intravenous dextrose Correct answer.
  2. Administer naloxone
  3. Start CPR
  4. Place him in the recovery position

Explanation

If a patient with hypoglycemia cannot protect the airway or does not respond to oral glucose, intravenous dextrose should be administered. Oral glucose is unsafe in an unresponsive patient. Naloxone is for opioid overdose, and CPR is for cardiac arrest.

Question 32Clinical EMS and Out-of-Hospital Emergency Care

A 35-year-old woman is 32 weeks pregnant and has a seizure. Which condition should be suspected first?

  1. Hypoglycemia
  2. Epilepsy
  3. Eclampsia Correct answer.
  4. Meningitis

Explanation

Seizures in a pregnant woman after 20 weeks of gestation should be considered eclampsia until proven otherwise. Immediate treatment includes magnesium sulfate. Epilepsy and other causes are possible but less likely in this context.

Question 33Clinical EMS and Out-of-Hospital Emergency Care

A 6-year-old child is choking on a piece of candy. He is unable to cough, speak, or breathe. What is the most appropriate immediate intervention?

  1. Administer back blows only
  2. Encourage forceful coughing
  3. Perform abdominal thrusts Correct answer.
  4. Perform blind finger sweeps

Explanation

For a conscious child with complete foreign body airway obstruction, abdominal thrusts (Heimlich maneuver) are recommended. Blind finger sweeps are not recommended because they can push the object further. Encouraging coughing is only for mild obstruction.

Question 34Clinical EMS and Out-of-Hospital Emergency Care

A 40-year-old man has a penetrating chest wound with air bubbling from the site. Which intervention is most appropriate?

  1. Apply a tight occlusive dressing
  2. Leave the wound uncovered
  3. Apply a vented chest seal Correct answer.
  4. Pack the wound with gauze

Explanation

A vented chest seal allows air to escape from the pleural space while preventing air entry, reducing the risk of tension pneumothorax. A completely occlusive dressing can trap air and cause tension pneumothorax. Packing and leaving uncovered are not appropriate.

Question 35Clinical EMS and Out-of-Hospital Emergency Care

A 28-year-old woman is in active labor and the baby's head is crowning. What is the most appropriate action?

  1. Instruct her to push forcefully
  2. Transport immediately in a moving vehicle
  3. Apply gentle pressure to the perineum
  4. Prepare for delivery at the scene Correct answer.

Explanation

When the head is crowning, delivery is imminent, and the prehospital provider should prepare to deliver at the scene. Pushing forcefully or applying pressure can cause injury. Transporting in a moving vehicle is unsafe if delivery is imminent.

Question 36Clinical EMS and Out-of-Hospital Emergency Care

A 65-year-old man is confused and has a blood pressure of 160/90 mm Hg, heart rate 80, and a blood glucose of 110 mg/dL. His wife reports a sudden onset of confusion one hour ago. Which condition should be highest on your differential?

  1. Migraine
  2. Hypoglycemia
  3. Stroke Correct answer.
  4. Sepsis

Explanation

Sudden onset of confusion in an older adult with hypertension should raise suspicion for stroke. Hypoglycemia is less likely with a normal glucose. Sepsis usually presents with fever and hypotension, and migraine typically causes headache.

Question 37Clinical EMS and Out-of-Hospital Emergency Care

A 50-year-old man has a sudden onset of severe tearing chest pain radiating to the back. His blood pressure is 180/100 mm Hg, and there is a 20 mm Hg difference between arms. Which condition is most likely?

  1. Acute myocardial infarction
  2. Pericarditis
  3. Aortic dissection Correct answer.
  4. Pulmonary embolism

Explanation

Severe tearing chest pain radiating to the back with unequal blood pressures suggests aortic dissection. Myocardial infarction usually causes pressure-like pain without blood pressure differential. Pericarditis and pulmonary embolism do not typically cause this presentation.

Question 38Clinical EMS and Out-of-Hospital Emergency Care

A 70-year-old woman is in cardiac arrest with a rhythm of asystole. Which intervention is indicated?

  1. Amiodarone 300 mg IV
  2. Epinephrine 1 mg IV Correct answer.
  3. Synchronized cardioversion
  4. Defibrillation

Explanation

For asystole, the treatment is CPR and epinephrine; defibrillation is not indicated for asystole. Amiodarone is used for shock-refractory ventricular fibrillation or pulseless ventricular tachycardia. Synchronized cardioversion is for unstable tachyarrhythmias with a pulse.

Question 39Clinical EMS and Out-of-Hospital Emergency Care

A 25-year-old man is rescued from a house fire. He has singed nasal hairs, soot in the oropharynx, and a hoarse voice. What is the most appropriate prehospital intervention?

  1. Apply a non-rebreather mask at 15 L/min
  2. Administer intravenous steroids
  3. Administer nebulized albuterol
  4. Perform early endotracheal intubation Correct answer.

Explanation

Signs of inhalation injury such as singed nasal hairs, soot, and hoarseness indicate impending airway obstruction, so early intubation is necessary. Oxygen alone may not be sufficient. Steroids and albuterol are not the primary treatment for airway edema.

Question 40Clinical EMS and Out-of-Hospital Emergency Care

A 22-year-old man has a deep laceration on his forearm with spurting bright red blood. Direct pressure is not controlling the bleeding. What is the next appropriate step?

  1. Pack the wound with gauze
  2. Elevate the arm only
  3. Apply a pressure dressing over the wound
  4. Apply a tourniquet proximal to the wound Correct answer.

Explanation

Arterial bleeding that is not controlled by direct pressure requires a tourniquet placed proximal to the wound. Elevation alone is insufficient. Pressure dressing and wound packing are used for venous or junctional bleeding, but a tourniquet is indicated for severe arterial hemorrhage.

Question 41Clinical EMS and Out-of-Hospital Emergency Care

A 60-year-old man is in respiratory distress with a history of heart failure. He has crackles in both lungs, jugular venous distension, and peripheral edema. Which medication is most appropriate?

  1. Epinephrine
  2. Albuterol
  3. Atropine
  4. Nitroglycerin Correct answer.

Explanation

Nitroglycerin reduces preload and afterload, improving symptoms in acute cardiogenic pulmonary edema. Albuterol is for bronchospasm, epinephrine for anaphylaxis or cardiac arrest, and atropine for bradycardia.

Question 42Clinical EMS and Out-of-Hospital Emergency Care

A 35-year-old woman is stung by a bee and within minutes develops hives, wheezing, and a blood pressure of 80/40 mm Hg. Which medication should be administered first?

  1. Epinephrine intramuscularly Correct answer.
  2. Albuterol nebulized
  3. Diphenhydramine
  4. Methylprednisolone intravenously

Explanation

Intramuscular epinephrine is the first-line treatment for anaphylaxis. Antihistamines, bronchodilators, and steroids are adjuncts but do not reverse the acute airway and cardiovascular effects as rapidly as epinephrine.

Question 43Clinical EMS and Out-of-Hospital Emergency Care

A 40-year-old man is found unresponsive with pinpoint pupils and a respiratory rate of 6 breaths/min. Which medication is indicated?

  1. Naloxone Correct answer.
  2. Flumazenil
  3. Atropine
  4. Glucagon

Explanation

Pinpoint pupils and respiratory depression suggest opioid overdose, for which naloxone is the antidote. Flumazenil is for benzodiazepine overdose, atropine for bradycardia, and glucagon for hypoglycemia or beta-blocker overdose.

Question 44Clinical EMS and Out-of-Hospital Emergency Care

A 28-year-old man has a suspected spinal injury after a diving accident. He is unresponsive and not breathing adequately. What is the most appropriate airway management?

  1. Perform head-tilt chin-lift
  2. Apply a cervical collar only
  3. Perform a blind nasotracheal intubation
  4. Perform jaw-thrust maneuver with manual stabilization Correct answer.

Explanation

In a patient with suspected spinal injury, the jaw-thrust maneuver with manual in-line stabilization is recommended to open the airway while minimizing spinal movement. Head-tilt chin-lift is contraindicated. Blind nasotracheal intubation is not first-line.

Question 45Clinical EMS and Out-of-Hospital Emergency Care

A 60-year-old woman has a sudden onset of weakness on the right side and difficulty speaking. Her blood glucose is 120 mg/dL. What is the most appropriate prehospital action?

  1. Administer aspirin
  2. Lower her blood pressure aggressively
  3. Determine the last known well time Correct answer.
  4. Give oral fluids

Explanation

Determining the last known well time is critical for stroke management, as it affects eligibility for thrombolytics. Aspirin is not given prehospital for stroke without CT. Lowering blood pressure aggressively and giving oral fluids are not recommended.

Question 46Clinical EMS and Out-of-Hospital Emergency Care

A 45-year-old man is trapped in a car and has a crushed leg. He is awake but pale and tachycardic. Which finding is most indicative of crush syndrome?

  1. Hypocalcemia
  2. Hyperkalemia Correct answer.
  3. Hypernatremia
  4. Hypokalemia

Explanation

Crush syndrome results from rhabdomyolysis, which releases potassium and myoglobin into the circulation, leading to hyperkalemia. Hypokalemia, hypernatremia, and hypocalcemia are not typical.

Question 47Clinical EMS and Out-of-Hospital Emergency Care

A 3-year-old child is in cardiac arrest. Which energy dose is appropriate for defibrillation?

  1. 20 J/kg
  2. 2 J/kg Correct answer.
  3. 4 J/kg
  4. 10 J/kg

Explanation

The initial defibrillation dose for pediatric patients is 2 J/kg. Subsequent doses may be increased to 4 J/kg. Higher doses are not recommended initially.

Question 48Clinical EMS and Out-of-Hospital Emergency Care

A 50-year-old man has a history of alcohol abuse and presents with confusion, ataxia, and ophthalmoplegia. Which condition is most likely?

  1. Alcohol intoxication
  2. Subdural hematoma
  3. Hepatic encephalopathy
  4. Wernicke encephalopathy Correct answer.

Explanation

The triad of confusion, ataxia, and ophthalmoplegia in a patient with alcohol use disorder suggests Wernicke encephalopathy due to thiamine deficiency. Treatment is thiamine administration. Hepatic encephalopathy, subdural hematoma, and alcohol intoxication do not typically present with this triad.

Question 49Clinical EMS and Out-of-Hospital Emergency Care

A 70-year-old woman is in cardiac arrest with a rhythm of pulseless electrical activity (PEA). Which intervention is indicated?

  1. Epinephrine 1 mg IV Correct answer.
  2. Amiodarone 300 mg IV
  3. Defibrillation
  4. Atropine 1 mg IV

Explanation

For PEA, the treatment is CPR and epinephrine; defibrillation is not indicated. Amiodarone is for shockable rhythms, and atropine is not recommended for PEA.

Question 50Clinical EMS and Out-of-Hospital Emergency Care

A 25-year-old man has a suspected tension pneumothorax and is deteriorating rapidly. Needle decompression is performed. What is the most appropriate subsequent action?

  1. Transport immediately for chest tube insertion Correct answer.
  2. Apply a chest seal
  3. Administer positive pressure ventilation
  4. Perform a second needle decompression

Explanation

After needle decompression, the patient requires definitive treatment with a chest tube, so immediate transport is necessary. Positive pressure ventilation may worsen the pneumothorax. A second decompression is not routine and a chest seal is for open pneumothorax.