Protocol Knowledge Exam (Basic/Advanced EMT)
Questions and Answers
- 1.
The current version of the Patient Care Guidelines (Protocols) went into effect:
- A.
January 1, 2012
- B.
January 1, 2014
- C.
July 1, 2013
- D.
They have not yet gone into effect
Correct Answer
B. January 1, 2014Explanation
The current PCGs went into effect at 0700 on January 1, 2014. The next update is scheduled for January 1, 2016.Rate this question:
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- 2.
In a patient experiencing no obvious distress, only once oxygen saturation falls below ___ % should you deliver supplemental O2:
- A.
98%
- B.
96%
- C.
94%
- D.
99%
Correct Answer
C. 94%Explanation
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.Rate this question:
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- 3.
The EMS provider can always overrule a patient's hospital choice:
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Unless a patient is deemed incapable of making decisions he or she chooses the final destination, even if the provider disagrees.Rate this question:
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- 4.
A patient with chest pain and computer generated EKG readout of ***Acute MI*** with a blood pressure of 85/45 is most likely experiencing ________ shock:
- A.
Cardiogenic
- B.
Anaphylactic
- C.
Septic
- D.
Neurogenic
- E.
Hemorrhagic
Correct Answer
A. CardiogenicExplanation
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)Rate this question:
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- 5.
When following the “Chest Pain” protocol a 12-lead EKG should be obtained and transmitted within ____ minutes of patient contact:
- A.
10
- B.
20
- C.
Once in the ambulance
- D.
30
- E.
90
Correct Answer
A. 10Explanation
AHA/ACC recommendations include a 10 minute timeframe in which EMS should obtain an EKG for all patients with suspected cardiac related chest painRate this question:
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- 6.
If the computer generates a reading of ***Acute MI*** and it is consistent with your patient's symptoms, scene time should be less than ____ minutes:
- A.
60
- B.
45
- C.
90
- D.
20
Correct Answer
D. 20Explanation
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.Rate this question:
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- 7.
ScenarioYou arrive on scene of a single family home and are directed by the patient's adult son to the bedroom. You see a 72 year-old female short of breath. The patient is sitting upright in obvious distress speaking in 2-3 word sentences. She denies pain but vigorously nods her head in the affirmative when asked, "is it hard to breath"? The son tells you she has had this sort of episode once before and "ended up on a ventilator".Meds: "something for blood pressure and a water pill"Vital Signs: P 122, BP 220/134, RR 30, O2 84% on room air, T 98.7 FPhysical Exam: tachycardic, tachypneic, lungs - coarse wet-sounding crackles to the bilateral mid lung fields, diaphoretic, lips pale_____________________________________________________________Which patient care guideline (protocol) is most appropriate to use:
- A.
Asthma/COPD
- B.
Congestive Heart Failure
- C.
No Resuscitation Indicated
- D.
Cardiogenic Shock
Correct Answer
B. Congestive Heart FailureExplanation
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.Rate this question:
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- 8.
ScenarioYou arrive on scene at the local church for a 57 year-old male not conscious, not breathing. As you make contact 40 bystanders have formed a circle around your patient with a family member performing CPR. While setting up your equipment the man's wife frantically tells you, "He hasn't been feeling well all morning, he just turned to me and said I think I'm going to be sick and collapsed!" She is unable to provide any further details.Meds: "something for blood pressure" but non-compliantVital signs: pulse not palpable, BP 0/0, RR agonal, PulseOx 40% on room airPhysical Exam: obese male unresponsive, skin still warm__________________________________________________________________Your first action in caring for this patient is:
- A.
Defibrillate
- B.
Place a supraglottic device for airway control
- C.
Instruct the bystander to continue CPR until EMS can take over
- D.
Tell the bystander to stop compressions while you prepare your equipment
Correct Answer
C. Instruct the bystander to continue CPR until EMS can take overExplanation
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.Rate this question:
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- 9.
You must remove all objects impaled in a patient's eye prior to ER arrival.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Removal of impaled objects without appropriate advanced equipment might be dangerous as surrounding tissues and blood vessel might be stabilized by its presenceRate this question:
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- 10.
In the following scenarios you must decide if it is appropriate to immobilize the patient._______________________________________________________________An 18 year-old unhelmeted male involved in an ATV accident. He was traveling at 30 mph, ejected, and according to his friend, was unconscious for about two (2) minutes. The patient has the smell of alcohol on his breath and admits to drinking but will not quantify. He has definite short-term memory deficit and is repeating questions. There is no obvious neurologic deficit but he has a six (6) cm deep laceration across his forehead.
- A.
Immobilize
- B.
Do Not Immobilize
Correct Answer
A. ImmobilizeExplanation
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".Rate this question:
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- 11.
A 34 year-old restrained driver involved in a two car MVC where his car was struck by a semi-trailer at approximately 40 mph. The patient denies loss of consciousness and although his vehicle is badly damaged he was ambulatory following the incident. He complains of bilateral wrist pain but there is no deformity and the patient rates his discomfort at 2/10. Vital signs and physical exam are unremarkable (except for mild tenderness to his wrists).
- A.
Immobilize
- B.
Do Not Immobilize
Correct Answer
B. Do Not ImmobilizeExplanation
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.Rate this question:
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- 12.
A 44 year-old male bicyclist hit by a car. Bystanders estimate the car's speed at 15 mph. They state the patient was thrown onto the hood, starred the windshield and fell onto the concrete. He was unresponsive for approximately one (1) minute. The patient is belligerent and uncooperative with immobilization but is convinced to be transported. He refuses all medical care and will only allow transport. Each time you attempt c-collar placement he grows angry and threatens to jump out of the moving ambulance.
- A.
Immobilize
- B.
Do Not Immobilize
Correct Answer
B. Do Not ImmobilizeExplanation
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.Rate this question:
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- 13.
An 18 year-old female at a house party reportedly jumped from the second story balcony on a "dare". She landed on her back but nobody is certain if she hit her head. The patient had not been drinking (yet) and has no focal neurologic complaint. Her friend says to your partner though "she's not acting right, she seems confused, and is definitely slower than normal."
- A.
Immobilize
- B.
Do Not Immobilize
Correct Answer
A. ImmobilizeExplanation
The patient's abnormal behavior makes her an unreliable historian. She should therefore be immobilized.Rate this question:
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- 14.
A 22 year-old male shot in the abdomen with no neurologic deficit.
- A.
Immobilize
- B.
Do Not Immobilize
Correct Answer
B. Do Not ImmobilizeExplanation
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.Rate this question:
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- 15.
An 86 year-old male fell from a park bench striking his forehead. He has a large abrasion and moderate swelling just below the frontal hairline. Although he denies neck pain he reports his arms feel heavy and weak. Vital signs and the remainder of the physical exam is unremarkable. You appropriately decide to immobilize the patient but once the c-collar is secured the patient reports difficulty breathing and states his arm weakness is worsening.
- A.
Immobilize
- B.
Do Not Immobilize
Correct Answer
B. Do Not ImmobilizeExplanation
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.Rate this question:
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- 16.
CPAP is an acceptable treatment for a COPD patient in severe respiratory distress:
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 17.
Normal Carbon Monoxide levels can be as high as 9% in a smoker:
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Carbon monoxide is a byproduct of tobacco burning. Smokers regularly inhale CO and over time reset their body's "normal" level.Rate this question:
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- 18.
You are en route to a possible shooting scene, law enforcement is a few minutes behind you. Arriving on scene you see a patient down in the front hallway through an open door. The scene has not been secured as law enforcement has not yet arrived. You should enter the building as long as you do not notice any obvious threat.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
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- 19.
The following etiologies are potential explanations for abnormal psychological behavior (circle all that apply):
- A.
Hypoglycemia
- B.
Stroke (Cerebrovascular Accident)
- C.
Seizure
- D.
Hypoxia
- E.
Poisoning
Correct Answer(s)
A. Hypoglycemia
B. Stroke (Cerebrovascular Accident)
C. Seizure
D. Hypoxia
E. PoisoningExplanation
All of the listed answers may lead to abnormal behavior and/or thought processes. Each creates alterations in normal brain function.Rate this question:
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- 20.
According to the patient care guidelines the following information must be included in the radio report of a suspected stroke victim (circle all that apply):
- A.
Last known well time
- B.
Cincinnati stroke scale
- C.
Allergies
- D.
Glucose
- E.
Primary physician
- F.
Past medical history
Correct Answer(s)
A. Last known well time
B. Cincinnati stroke scale
D. GlucoseExplanation
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.Rate this question:
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- 21.
"Triple Zero" (pulseless, non-breathing, asystole) can be confirmed on hypothermic patients:
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
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- 22.
You are delivering a victim of a radiation emergency but did not have time to warn hospital personnel. It is still acceptable to park inside the garage (i.e., ambulance bay):
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
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- 23.
With each additional pregnancy the duration of time between onset of labor and delivery decreases (e.g., a woman delivering for the fifth time will deliver faster than a woman delivering for the second time):
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 24.
The following actions are appropriate during emergency childbirth (circle all that apply):
- A.
Ensure the umbilical cord is not wrapped around the infant's neck
- B.
Pull vigorously on the umbilical cord once the child has delivered so the placenta will rapidly appear.
- C.
If the presenting part is an arm or leg, pull until the rest of the baby emerges
- D.
Begin CPR if the infant's pulse is less than 60 bpm
- E.
Gently massage the fundus after successful delivery of child and placenta
Correct Answer(s)
A. Ensure the umbilical cord is not wrapped around the infant's neck
D. Begin CPR if the infant's pulse is less than 60 bpm
E. Gently massage the fundus after successful delivery of child and placentaExplanation
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.Rate this question:
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- 25.
If the presenting part is the umbilical cord ("prolapsed cord") do the following (circle all that apply):
- A.
Pull vigorously
- B.
Place a gloved hand inside the vagina to relieve pressure on the cord
- C.
Place mother in Trendelenburg and knees to chest
- D.
Close mother's legs and make your partner take over
Correct Answer(s)
B. Place a gloved hand inside the vagina to relieve pressure on the cord
C. Place mother in Trendelenburg and knees to chestExplanation
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.Rate this question:
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- 26.
Routine trauma care for a pregnant patient, especially if she is hypotensive, includes positioning the patient:
- A.
Seated upright
- B.
Left side downward
- C.
Right side downward
Correct Answer
B. Left side downwardExplanation
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.Rate this question:
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- 27.
It is acceptable to use an "adult" AED on an infant if it is the only one available:
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 28.
A child who woke from sleep at 1 a.m. with a fever of 102 F, harsh sounding cough, but no wheezing on lung auscultation is most likely suffering from:
- A.
Asthma
- B.
Croup
- C.
Congestive Heart Failure
- D.
Pneumothorax
Correct Answer
B. CroupExplanation
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).Rate this question:
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- 29.
You suspect a pediatric patient is the victim of abuse but the parents are refusing your care. It is okay to leave the scene before law enforcement arrive:
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
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Jun 09, 2023Quiz Edited by
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Jun 28, 2014Quiz Created by
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