Protocol Knowledge Exam (Basic/Advanced EMT)

Removal of impaled objects without appropriate advanced equipment might be dangerous as surrounding tissues and blood vessel might be stabilized by its presence

The patient both admits to and smells of alcohol. He is asking questions repetitively. Both elements make him an unreliable historian and therefore not a candidate for c-spine "clearance".

Under no circumstance is it acceptable to enter a scene without confirmation of safety. Law enforcement will either "clear" an area via direct communication to you or to the EMS officer once it is okay to engage the patient.

Generally speaking croup is manifested by abnormal sounds of the upper airway (e.g., trachea) while asthma includes the lower airways (e.g., bronchioles). Difficulty or swelling of the upper airway create inspiratory noises typically labeled as stridor while lower airway narrowing create expiratory noises labeled wheezing. Croup will often times include a fever and nighttime waking while asthma will generally not have an associated fever unless accompanied by a lower respiratory tract infection (e.g., pneumonia).

The patient's abnormal behavior makes her an unreliable historian. She should therefore be immobilized.

AHA/ACC recommendations include a scene time of less than 20 minutes for patients suffering a heart attack since heart muscle is dying until the blood vessel occlusion is removed. More heart muscle death impacts both immediate and long-term patient outcomes.

Carbon monoxide is a byproduct of tobacco burning. Smokers regularly inhale CO and over time reset their body's "normal" level.

You must wait outside the hospital structure until appropriate precautions have been taken when delivering a patient exposed to chemical, biological, nuclear, or radiation elements. If that patient enters the garage or hospital without proper safeguards he or she may contaminate staff and render the facility inoperable for an extended period of time.

Recent pre-hospital literature confirms what many have known for some time - too much oxygen is harmful. Oxygen is a free radical with harmful effects on many body tissues, the more we use the worse the effect. Another theory suggests high levels of oxygen "wash out" nitrogen in the lungs. Since nitrogen secretes surfactant (the chemical responsible for keeping alveoli open), its absence means lung collapse.

You must remain on scene, at a safe distance if necessary, until law enforcement arrives in this scenario. Leaving before they arrive could constitute abandonment and place the child in further danger.

The introduction of CPAP has prevented many patients from intubation. Virtually all patients in severe respiratory distress could benefit from this technique, especially if intubation is being considered but not an imminent need.

Hypothermia, if significant, can lower all body functions and might even create transient apnea or pulselessness. Patients have been successfully resuscitated after incredible duration following cold water submersion or prolonged hypothermia.

Although one could argue the injury to the abdomen would constitute a "distracting" injury the guidelines clearly state a penetrating injury without neurologic deficit should not be immobilize. If this individual reported the inability to move his legs, indicating a thoracic or lumbar spinal cord injury immobilization would be appropriate.

In a patient experiencing an acute coronary event (e.g., ST elevation myocardial infarction or "heart attack") the most likely source of their hypotension is poor cardiac output from an injured heart muscle. The other sources of shock have preserved heart function and instead a failure of the vasculature to maintain adequate pressure. This distinction is critical as the treatments are different and if delivered inappropriately can exacerbate the shock state (e.g., aggressive IV fluid therapy will help someone in septic shock but may kill a patient in cardiogenic shock)

AHA accepts the above. If a child is at risk of imminent cardiac death the energy of an adult AED, although not preferred, is better than no intervention.

The current PCGs went into effect at 0700 on January 1, 2014. The next update is scheduled for January 1, 2016.

A mother with multiple previous deliveries will most likely complete delivery much more quickly than a mother delivering for the first or second time. It is therefore important you obtain pregnancy and delivery history from a patient complaining of abdominal pain in pregnancy.

The gravid uterus can compress the Inferior Vena Cava (IVC) and inhibit adequate blood return from the legs. By positioning the pregnant patient in a left lateral recumbent position the uterus drifts toward the left pelvis and away from the IVC positioned on the right.

AHA/ACC recommendations include a 10 minute timeframe in which EMS should obtain an EKG for all patients with suspected cardiac related chest pain

The American College of Obstetricians recommends the above checked answers. Strangulation by an umbilical cord can lead to death and should be address emergently during childbirth. Once the child is delivered massaging the mother's fundus will help slow bleeding and contribute to increase muscle tone of the uterus. In contrast, pulling on the cord, leg, or arm is potentially dangerous and could lead to injury of the child or mother. A newborn's heart rate should be much higher than 60 bpm and at that number might indicate impending cardiovascular collapse.

Although the mechanism and damage to the patient's vehicle in this scenario is concerning his physical exam and lucid state make him reliable. His wrist discomfort should not be interpreted as a distracting injury, as opposed to a femur or humerus fracture.

Unless a patient is deemed incapable of making decisions he or she chooses the final destination, even if the provider disagrees.

Recent resuscitation literature confirms that compression pauses, no matter how short, are dangerous and bestow worse patient outcomes. It is imperative as an EMS provider that you control your scene. Part of that obligation includes bystander instruction. In this case all other answers are either incorrect or come secondary to compression continuation.

All of the listed answers may lead to abnormal behavior and/or thought processes. Each creates alterations in normal brain function.

By repositioning the mother in Trendelenburg and relieving pressure on the prolapsed cord you permit continual and adequate blood flow to the undelivered baby. Although we might all prefer to step aside and force our partner to take over this scenario that is not quite appropriate.

This patient is clearly showing signs of a head injury. Ideally he would be cooperative and a c-collar would be utilized. However judgement, in this scenario, should dictate that patient and provider safety might be jeopardized by forceably placing a rigid collar on a combative patient. It should therefore be withheld.

This individual is showing signs of Central Cord Syndrome, a fairly common incomplete spinal cord injury characterized by disproportionate motor dysfunction in the arms compared to the legs. It is most often seen in hyperextension injuries. Forces generated at the point of injury generally exceed any force produced by field providers, even when placing immobilization equipment. You can be reassured that foregoing immobilization in this individual will carry very low risk of worsening his spinal cord injury. By keeping the c-collar in place when the patient clearly explains worsening symptoms is unsafe and should be avoided even though spinal immobilization guidelines include him.

This patient is displaying signs and symptoms consistent with congestive heart failure. The most significant indication is her lung sounds, described as "wet-sounding" and "crackles". Typically asthma/COPD exacerbations include "wheezing". In addition this patient is on "a water pill" further supporting her history of CHF. She is not in shock and, in fact, is experiencing hypertensive crisis. She clearly needs resuscitation, making answer C incorrect.

The AHA and ASA recommend the three above correct answers as critical pieces of information when caring for a suspected stroke victim as these are the most important drivers of medical decision-making. The last known well time, if greater than 4.5 hours, will eliminate a patient as a candidate for tPA ("clot buster"). The Cincinnati stroke scale will distinguish between stroke and alternative diagnoses. While significant hypoglycemia can mimic stroke symptoms and is easily correctable. Administering a potentially dangerous drug, like tPA, to a patient whose symptoms could be corrected by dextrose or a turkey sandwich might be catastrophic.