NREMT EMT — All Questions

What is the first-line method to control severe, life-threatening external bleeding from an extremity?

• a.Direct pressure, and a tourniquet if pressure fails or bleeding is massive✓
• b.Packing the wound with ice to constrict the bleeding vessels
• c.Elevating the injured limb well above the level of the heart
• d.Pressing a proximal arterial pressure point instead of the wound

Severe extremity bleeding is controlled first with firm direct pressure, and a tourniquet is applied if that fails or the bleeding is immediately life-threatening. Ice, elevation, and proximal pressure points do not reliably stop a major bleed and they delay the measures that do. Rapid hemorrhage control is a top priority in trauma.

When applying a commercial tourniquet, you should tighten it until:

• a.You can still slide a finger under the strap when it is set
• b.The distal pulse weakens but can still be felt
• c.The bright red bleeding stops and the distal pulse is eliminated✓
• d.The patient reports the pressure has become painful

A tourniquet must be tightened enough to stop arterial bleeding, which also eliminates the distal pulse. A tourniquet that only slows bleeding can worsen blood loss. A strap loose enough to admit a finger, or one that leaves a palpable pulse below it, still lets arterial blood into the limb while blocking venous return, so the wound keeps bleeding. Pain is not the endpoint either: a correctly applied tourniquet hurts, and a patient in shock may feel little.

Which are early signs of shock (hypoperfusion)?

• a.Falling blood pressure as the first sign
• b.High blood pressure and dry skin
• c.Rapid pulse; pale, cool, clammy skin; and anxiety✓
• d.Slow pulse and warm, flushed skin

Early shock produces a rapid, weak pulse with pale, cool, clammy skin and restlessness or anxiety. Falling blood pressure is a late sign because the body compensates first.

After applying a tourniquet, you should note and communicate:

• a.Only the amount of blood lost
• b.The patient's pain level instead
• c.The time the tourniquet was applied✓
• d.The brand of device applied

The application time of a tourniquet must be documented and reported so hospital staff know how long the limb has been without circulation. Write it clearly, often on the patient or the device. Estimated blood loss, pain and the type of device are all worth reporting, but none of them tells the receiving team how long the limb has been ischemic, which is what drives their decisions about the limb.

Under a typical EMS protocol, a patient with a suspected spinal injury who is breathing adequately should be:

• a.Positioned with the head turned to the side
• b.Manually stabilized in a neutral, in-line position✓
• c.Asked to move the neck to test its range first
• d.Placed prone on the stretcher for transport

Suspected spinal injuries are managed with manual in-line stabilization keeping the head neutral until fully immobilized or cleared. Unnecessary movement risks worsening a spinal cord injury. Turning the head to the side or placing the patient prone moves the very segment being protected and makes reassessment of the airway and chest harder. Asking the patient to move the neck to find the limits of motion can convert an unstable fracture into a cord injury; tenderness and deficit are assessed without moving the spine.

How should a partial-thickness (second-degree) burn without gross contamination be initially covered?

• a.With ice packs applied directly on the skin
• b.With a tight elastic wrap
• c.With butter or ointment
• d.With a clean, dry sterile dressing✓

Burns are covered with a clean, dry sterile dressing to reduce contamination and pain. Avoid ointments, butter, ice, or breaking blisters, which can worsen injury or infection.

The 'rule of nines' is used to estimate:

• a.The Glasgow Coma Scale score after a head injury
• b.The percentage of total body surface area burned✓
• c.The respiratory rate in an injured patient
• d.The volume of blood lost from an open wound

The rule of nines estimates the percentage of total body surface area burned, which gauges burn severity and guides triage and transport decisions. It has nothing to do with scoring consciousness, counting respirations, or measuring blood loss.

An impaled object in a patient's forearm should generally be:

• a.Pushed in deeper for stability
• b.Removed quickly to control bleeding
• c.Stabilized in place with bulky dressings✓
• d.Wrapped tightly against the skin

Impaled objects are stabilized in place and not removed in the field, because removal can cause severe bleeding or further injury. The exception is an object obstructing the airway or interfering with CPR.

The most appropriate position for a hypotensive trauma patient in shock (without spinal injury) is generally:

• a.Walking the patient to keep the circulation moving
• b.Supine to maintain perfusion, keeping the patient warm✓
• c.Face down, to protect the airway from vomiting
• d.Sitting fully upright to make breathing easier

A patient in shock is generally kept supine to support perfusion of the vital organs, along with oxygen and steps to prevent heat loss, since losing heat makes shock worse. Walking a hypotensive patient can cause collapse, sitting fully upright reduces blood return to the brain, and lying face down makes assessment and airway management harder.

Under a typical EMS protocol, a patient with a suspected closed femur fracture should have the limb:

• a.Left unsplinted so the patient can hold the leg in whatever position hurts least
• b.Elevated above the level of the heart on pillows to limit swelling and bleeding
• c.Gently massaged and straightened by hand before the patient is moved to the cot
• d.Immobilized, ideally with a traction or rigid splint, checking distal pulse, motor, and sensation✓

A femur fracture is stabilized with a splint to limit pain, bleeding, and further injury, and distal pulse, motor function, and sensation are checked before and after splinting. A femur can bleed heavily into the thigh, so leaving the limb unsupported, elevating it on pillows, or manipulating it by hand increases both pain and blood loss.

Which finding suggests a serious chest injury requiring rapid transport?

• a.Mild chest soreness with clear, equal breath sounds
• b.Pink, warm skin with an unlabored, regular breathing pattern
• c.Severe difficulty breathing with unequal chest rise after chest trauma✓
• d.A small superficial scratch over the ribs with no tenderness

Severe difficulty breathing with unequal chest rise after chest trauma suggests a serious injury such as a collapsed lung and calls for oxygen and rapid transport. Mild soreness with clear and equal breath sounds, normal skin with easy breathing, or a superficial scratch do not carry that level of urgency.

Under a typical EMS protocol, an open chest wound (sucking chest wound) should be treated by an EMT with:

• a.Gauze packed deep into the wound and held with pressure
• b.An occlusive dressing, monitoring for worsening breathing✓
• c.A tight circumferential wrap around the whole chest
• d.Oxygen alone, leaving the wound open to the air

An open chest wound is covered with an occlusive dressing to prevent air entering the chest, while watching for signs of increasing pressure. If breathing worsens, a side of the dressing may be lifted to release trapped air. Packing gauze into a chest wound pushes material toward the lung and does not seal it, and a tight wrap around the chest limits the movement the patient needs to breathe. Leaving the wound open lets air continue to be drawn into the pleural space with every breath.

The primary goal of treating shock in a trauma patient in the field is to:

• a.Stay on scene until the blood pressure comes back up on its own
• b.Raise the blood pressure by having the patient drink fluids on scene
• c.Maintain oxygenation and perfusion and prevent heat loss during rapid transport✓
• d.Give small sips of water and something to eat to keep strength up

Field management of shock focuses on oxygenation and perfusion, controlling bleeding, preventing heat loss, and moving quickly to definitive care, because an EMT cannot reverse shock in the field. Waiting on scene for the blood pressure to improve wastes that time, and nothing is given by mouth to a patient who may vomit or who may need surgery.

Bright red blood that spurts from a wound in time with the pulse indicates:

• a.Minor bleeding that will stop on its own
• b.Venous bleeding
• c.Capillary bleeding
• d.Arterial bleeding✓

Spurting, bright red blood synchronized with the heartbeat is arterial bleeding, which is the most serious and rapid. It requires immediate control with direct pressure and possibly a tourniquet.

A helmet on a patient with a possible spine injury should generally be removed by EMTs when:

• a.The patient asks for it to be taken off, no matter how well it fits
• b.Never, because taking a helmet off will always worsen a spinal injury
• c.It interferes with airway management or assessment, or does not hold the head snugly✓
• d.Only after arrival at the hospital, where the staff can take it off

A helmet is removed when it blocks airway management or assessment, or when it does not hold the head snugly enough to help immobilize it. A well-fitting helmet that holds the head steady may be left in place with the head stabilized, so removal is neither automatic on request nor something that must wait for the hospital.

To estimate the severity of a head injury, an EMT commonly assesses:

• a.The blood pressure alone, watching for a rising reading
• b.Pupil size and reaction only, without tracking mental status
• c.Skin temperature and color alone, with no neurologic check
• d.Level of responsiveness (AVPU/GCS), pupils, and any change over time✓

Head injury severity is judged from level of responsiveness, pupil size and reaction, and how those findings trend over time, since a declining mental status is the critical warning sign of a worsening brain injury. Blood pressure, pupils, or skin findings taken by themselves miss that trend.

An EMT applies a hemostatic gauze to a bleeding wound that a tourniquet cannot reach. What must accompany its use?

• a.Packing the gauze into the wound and holding direct pressure for the stated time✓
• b.Irrigating the wound with sterile saline first so the agent is not diluted by contaminated blood
• c.Removing and replacing the gauze every few minutes so a fresh dose of the agent is applied
• d.Laying the gauze over the wound and covering it with a pressure bandage, without packing it

Hemostatic dressings work only when they are packed down into the wound so the agent contacts the bleeding vessel, then held under uninterrupted direct pressure for the time the manufacturer specifies — commonly three minutes for the products carried on ambulances. Lifting the dressing to look, or replacing it for a fresh dose, tears away the clot that is forming and restarts the bleeding. Laying gauze on the surface leaves the vessel deep in the wound untamped, and irrigating first delays the pressure that is what actually stops the hemorrhage.

A patient has an open tibia fracture with bone visible in the wound. How should the EMT manage it?

• a.Cover with a sterile dressing, splint as found, and do not push the bone back in✓
• b.Irrigate the exposed bone with sterile saline and then draw it gently back under the skin
• c.Apply traction to the leg until the bone end retracts, then splint the limb in alignment
• d.Apply a tourniquet proximal to the wound, since every open fracture bleeds significantly

An open fracture is covered with a sterile dressing and splinted in the position found, and protruding bone is neither pushed nor pulled back inside, because that carries surface contamination deep into the wound and into the bone itself. Distal pulse, motor function and sensation are checked before and after splinting, and the fact that the bone may slip back under the skin as the limb is splinted is documented and passed on. Traction splinting is for a closed midshaft femur fracture, not a way to reduce exposed tibia. A tourniquet is reserved for bleeding that direct pressure cannot control — most open fractures do not bleed at that rate, and applying one routinely causes avoidable ischemia.

A patient has an obvious shoulder dislocation with the arm held away from the body and a strong radial pulse. What is the appropriate field management?

• a.Reduce the dislocation by applying steady traction until the joint returns into place
• b.Splint the arm in the position found and support it with padding✓
• c.Move the arm to the patient's side and secure it with a sling and swathe for comfort
• d.Apply ice and move the joint gently through its range to confirm that it is truly dislocated

A dislocated joint is splinted in the position in which it is found, padded and supported — often with a pillow in the gap between the arm and the chest — and distal pulse, motor function and sensation are checked before and after. A sling and swathe is the competing answer, and it is right for many arm injuries, but it requires bringing the arm to the chest wall; forcing a dislocated shoulder into that position can stretch or compress the axillary nerve and vessels and convert a stable injury into a limb-threatening one. Reduction is not an EMT skill except where the distal pulse is absent and local protocol specifically authorizes it, and moving the joint to test it risks further damage.

An electrician was shocked by a high-voltage line and has small burns on one hand and one foot. Why does this patient need a high level of concern despite the small visible burns?

• a.Current travelling between the wounds can injure deep tissue and disturb the heart rhythm✓
• b.The main risk is fluid loss from the burned surface, so shock follows the burned area
• c.The entry and exit wounds show the full extent of the injury and are treated as burns
• d.The patient will be in severe pain, which by itself causes shock in electrical injuries

The wounds mark only where the current entered and left; everything along the path between them — muscle, blood vessels, nerves and the heart's conduction system — may be destroyed with no external sign, so the patient is monitored for dysrhythmias and transported even when the skin looks almost normal. Massive deep muscle destruction also releases myoglobin, which can injure the kidneys. Sizing the injury by burned surface area is the classic underestimate, and fluid loss from two small burns is not what threatens this patient. Pain does not by itself cause shock.

Which finding on a blunt abdominal trauma patient most strongly suggests significant internal injury?

• a.A single small abrasion across the lower abdomen from the lap portion of a seat belt
• b.Nausea reported by the patient with no tenderness anywhere on gentle palpation
• c.A soft abdomen that is mildly tender directly over the site of the reported impact
• d.A rigid, distended abdomen with a rising pulse and a falling blood pressure✓

Rigidity and distention together with a rising pulse and a falling blood pressure indicate blood accumulating in the abdomen — a load-and-go finding rather than something to keep assessing on scene. A seat-belt mark is the answer worth weighing against it, because it is a genuine red flag for bowel, mesenteric and lumbar-spine injury and should be reported; but it describes a risk of injury, whereas the rigid abdomen with failing vital signs is evidence that bleeding is already happening. Mild localized tenderness and nausea are common after any blunt impact and do not distinguish anything on their own.

An alkaline drain cleaner has splashed into a patient's eye. What is the correct field care?

• a.Irrigate for one minute, then patch the eye so the cornea is protected during transport
• b.Cover both eyes with dry sterile dressings and transport without irrigating the eye at all
• c.Irrigate continuously with water or saline from the inner corner outward, and keep irrigating en route✓
• d.Instill a neutralizing solution into the eye first, then irrigate once the reaction has stopped

Chemical eye injury is treated with immediate, continuous irrigation that carries on throughout transport, directed from the bridge of the nose outward so that runoff does not wash the chemical into the unaffected eye. Alkalis are the worst case because they keep penetrating the cornea for as long as they remain in contact with it, so time is the whole treatment. Stopping after a minute or patching the eye seals the chemical against the cornea, and dry dressings with no irrigation do the same. A neutralizing agent is never instilled, because the neutralization reaction itself releases heat into an already injured eye.

A trauma patient with significant blood loss is being packaged on a warm summer evening. Why does the EMT still work to keep the patient warm?

• a.Because shivering raises the patient's blood pressure and helps compensate for the loss
• b.Because warmth speeds the body's replacement of the red blood cells that were lost
• c.Because a cold patient's blood clots poorly, which worsens the bleeding✓
• d.Because a warm patient tolerates the ambulance ride with less pain and less anxiety

Clotting depends on enzymes that work poorly as the patient cools, so hypothermia, acidosis and impaired clotting reinforce one another in a bleeding patient — which is why blankets and a warm patient compartment are treatment rather than comfort. A patient who is bleeding cools quickly even in warm weather, especially once clothing has been cut away and cool air is blowing over the skin. Shivering consumes oxygen and generates acid rather than helping, and red cells are not replaced in the timeframe of an ambulance call. Comfort is a real benefit, but it is not why this is done.

After an explosion, which injury pattern is caused by the primary blast wave rather than by debris or by being thrown?

• a.Penetrating wounds to the torso and limbs from fragments propelled by the explosion
• b.Fractures and head injury sustained when the patient was thrown against a solid wall
• c.Injury to air-filled organs such as the lungs, middle ear, and bowel✓
• d.Burns to exposed skin and airway from the fireball that followed the detonation

The primary blast wave compresses and then releases gas-filled structures, so the lungs, tympanic membranes and bowel take the damage, and blast lung can develop with no external mark at all. Fragment wounds are secondary injuries, being thrown against a surface is tertiary, and burns, crush injury and inhaled toxins are grouped as quaternary. Recognizing the primary pattern matters precisely because it is the one that leaves nothing to see, so a patient who looks unhurt after a blast is still watched for worsening breathing.

An 84-year-old fell at home and has a shortened, externally rotated right leg with pain in the hip. How should the EMT package this patient?

• a.Apply a traction splint to the injured leg, since the mechanism and deformity match its use
• b.Support the leg with padding in the position found and move the patient as one unit✓
• c.Apply a pelvic binder, since a shortened, rotated leg after a fall indicates an unstable pelvis
• d.Straighten the leg into anatomical alignment and secure both legs together with cravats

A shortened, externally rotated leg with hip pain after a low-energy fall in an elderly patient is the classic proximal femur fracture. It is supported with padding in the position of comfort and the patient is moved as a single unit with a scoop stretcher or a sheet, so that the fracture is not manipulated. A traction splint is the answer that catches candidates who match the words shortened and rotated to a femur: traction splints are indicated for a midshaft femur fracture and are contraindicated when the injury is at the hip or the pelvis, because pulling on it can worsen the fracture and the bleeding. A pelvic binder is for a suspected unstable pelvic ring injury, which presents with pelvic pain and instability rather than an isolated painful hip. Weight bearing is never used to test for a fracture.

Which patient most clearly meets the kind of physiological criterion that trauma triage guidelines use to direct transport to the highest-level trauma center available?

• a.A patient with a two-inch scalp laceration that has already been controlled by pressure
• b.A patient with an isolated closed forearm fracture who reports the pain as severe
• c.A patient with a systolic blood pressure of 82 and a decreased level of consciousness✓
• d.A patient involved in a rollover crash who is alert with entirely normal vital signs

Field triage guidelines are worked through in order, and the first step is physiological: a Glasgow Coma Scale of 13 or less, a systolic blood pressure below 90 mmHg, or a respiratory rate below 10 or above 29. A systolic pressure of 82 is below that 90 mmHg threshold, and a decreased level of consciousness meets the mental-status criterion, so this patient satisfies the first step twice over. A rollover crash is the closest competing answer, and it does raise suspicion, but it is a mechanism criterion — mechanism sits below physiology and anatomy in the sequence precisely because normal vital signs after a dramatic crash are common. An isolated closed forearm fracture and a controlled scalp laceration meet no criterion in any category. Thresholds and the actual destination are set by each region's trauma system and local protocol.

Direct pressure has not controlled bleeding from a deep wound in the groin, and the site is too high for a tourniquet. Under a typical EMS protocol, what should the EMT do next?

• a.Pack the wound with gauze and hold firm pressure directly over the packed site✓
• b.Apply a tourniquet as far up the thigh as it will reach and tighten it fully
• c.Elevate the leg above the level of the heart and apply pressure over the femoral artery
• d.Apply a bulky pressure dressing over the first one and wrap it tightly with an elastic bandage

A junctional wound at the groin, axilla or neck is packed with plain or hemostatic gauze and held under firm, continuous pressure, because a tourniquet cannot be placed proximal to it. The high-thigh tourniquet is the tempting answer, and a tourniquet is right for a limb wound, but a device that sits below the bleeding vessel controls nothing. Stacking dressings hides ongoing blood loss and moves the pressure away from the source. Elevation and pressure points are no longer taught as bleeding-control steps, because neither was ever shown to control severe hemorrhage.

A patient has been struck in the chest and has distended neck veins, absent breath sounds on one side, and a falling blood pressure. Which type of shock does this pattern represent?

• a.Hypovolemic shock
• b.Distributive shock
• c.Obstructive shock✓
• d.Cardiogenic shock

Rising pressure inside the chest keeps blood from returning to the heart, so the heart has nothing to pump; that is obstructive shock, and the likely cause here is a tension pneumothorax. Hypovolemic shock is the close call, because a hemothorax also follows blunt chest trauma and also takes away breath sounds on one side — but blood loss flattens the neck veins instead of distending them, and that single finding separates the two. Distributive shock follows widespread vasodilation, as in anaphylaxis or neurogenic shock, and would not silence one lung. Cardiogenic shock follows pump failure; a blow to the chest can bruise the myocardium, but that does not produce unilateral absent breath sounds.

A child has been rescued from a house fire. Which finding most strongly suggests an inhalation injury that will need aggressive airway management?

• a.Superficial burns across both forearms sustained while shielding the face
• b.Anxiety and restlessness with a heart rate of 130 after being carried from the smoke
• c.A respiratory rate of 30 with clear lung sounds throughout both fields
• d.Soot around the nostrils with singed nasal hair and a hoarse, strained voice✓

Soot in the nose or mouth, singed nasal or facial hair, and a hoarse or stridorous voice point to thermal and chemical injury to the upper airway, which can swell shut over the following hour. Restlessness with a fast heart rate is the finding worth a second look, since it can be early hypoxia — but it is a reason to reassess oxygenation, not evidence that the airway itself is burned. Superficial burns on the forearms and a raised respiratory rate are both expected after a fire and neither localises the injury to the airway.

A worker has dry lime powder spilled across a forearm. What is the correct first step in caring for this chemical burn?

• a.Flush immediately with copious water for at least twenty minutes, then cover the arm
• b.Neutralize the lime with a weak acid solution before any water is applied to the skin
• c.Brush the dry powder off the skin first, then flush the area with copious running water✓
• d.Cover the arm with a dry sterile dressing and let the emergency department remove the powder

A dry chemical is brushed off first, because water applied to dry lime activates it and can deepen the burn; once the powder is off, the site is irrigated with large volumes of running water. Immediate flushing is the genuinely tempting answer, and it is correct for a liquid chemical, but with a dry powder the brushing step comes first. Neutralizing agents are not applied in the field, since the neutralization reaction itself generates heat. Leaving the powder in place lets it keep reacting with moisture on the skin all the way to the hospital.

An adult has partial-thickness burns covering the entire front and back of one leg and the entire front of the torso. Using the adult rule of nines, what percentage of body surface area is burned?

• a.18 percent
• b.36 percent✓
• c.27 percent
• d.54 percent

In the adult rule of nines an entire lower limb is 18 percent (9 percent front plus 9 percent back) and the anterior trunk is 18 percent, so 18 + 18 = 36 percent. Counting only one surface of the leg and only half the anterior trunk gives 9 + 9 = 18. Counting the leg correctly at 18 but the anterior trunk as 9 gives 27, and treating the anterior trunk as a single 9 is the most common slip. Counting the whole trunk, front and back, gives 18 + 36 = 54, but the posterior trunk is not burned in this patient.

An EMT is preparing to splint a forearm that is obviously deformed. Which step must be performed both before and after the splint is applied?

• a.Straightening the angulation so the limb lies in normal anatomical position
• b.Checking pulse, motor function, and sensation distal to the injury✓
• c.Padding the voids between the limb and the splint before securing the straps
• d.Covering any open wound with a sterile dressing to reduce contamination

Distal pulse, motor function and sensation are documented before the splint goes on and rechecked immediately afterward, because a splint applied too tightly can compromise circulation that was intact a minute earlier. Padding the voids and covering an open wound are both real and necessary steps, which is what makes them tempting, but each is done once, before the splint, and neither is repeated as a circulation check. Realigning an angulated limb is done only when the distal pulse is absent and local protocol permits, so it is not a routine step at all.

Under typical EMS protocols and traction-splint manufacturer instructions, which finding is a contraindication to applying a traction splint to a suspected midshaft femur fracture?

• a.A closed fracture with obvious deformity and shortening of the injured leg
• b.Significant pain and swelling of the thigh with an intact distal pulse
• c.An associated injury to the pelvis, knee, or lower leg on the same side✓
• d.A distal pulse that is weaker on the injured side than on the other

A traction splint pulls against the pelvis at one end and the ankle at the other, so a fracture or dislocation of the pelvis, hip, knee, tibia, fibula or ankle on that side is a contraindication — the device would drag force through a second injury. The weak distal pulse is the option that catches prepared candidates: it demands careful reassessment and rapid transport, but it is not a reason to withhold traction, since restoring length often improves distal circulation. A closed midshaft femur fracture with deformity and shortening is the classic indication, and severe pain with an intact pulse is simply the expected presentation.

A patient struck in the head is initially alert but over ten minutes becomes drowsy, with a rising blood pressure, a slowing pulse, and irregular breathing. What does this pattern indicate?

• a.Hypovolemic shock from bleeding into the scalp
• b.Rising intracranial pressure✓
• c.A vasovagal reaction to the pain
• d.An expected course after a concussion

A rising blood pressure with a falling pulse and an irregular breathing pattern is the Cushing triad of rising intracranial pressure, and the declining mental status makes this a load-and-go patient. Hypovolemic shock moves the vital signs the other way — pressure down, pulse up — so scalp bleeding does not explain this picture even though the scalp bleeds freely. A vasovagal reaction lowers both the pressure and the pulse and does not progressively depress consciousness. Drowsiness alone is common after a concussion, but a course that worsens over ten minutes alongside these vital signs is not an expected recovery.

Which set of findings suggests a basilar skull fracture?

• a.Bruising behind the ears and around both eyes with clear fluid draining from the nose✓
• b.A boggy swelling over the parietal area with a laceration through the scalp
• c.Unequal pupils with weakness of the arm and leg on one side of the body
• d.Steady bleeding from a scalp wound that soaks through several trauma dressings in minutes

Battle's sign behind the ears, raccoon eyes around the orbits, and clear or blood-tinged cerebrospinal fluid from the nose or ears together point to a fracture of the skull base, and nothing is packed into the ear or nose to stop that drainage. Unequal pupils with one-sided weakness is the strongest competing answer, because it is also an ominous head-injury finding — but it indicates a mass pressing on the brain rather than locating a fracture of the base. A scalp hematoma or a briskly bleeding laceration indicates local injury only.

A restrained driver in a low-speed collision is alert, has no midline spinal tenderness, no neurological complaint, and is not intoxicated or distracted by another injury. Under many current EMS protocols, what is the appropriate spinal care?

• a.Apply a cervical collar and secure the patient to a long backboard for transport
• b.Restrict motion with a vacuum mattress, since low-speed crashes still transmit force
• c.Apply a cervical collar only
• d.No spinal motion restriction is indicated for this patient✓

Selective spinal motion restriction protocols let an EMT withhold restriction when the patient is alert and sober, has no midline tenderness, no neurological deficit and no distracting injury — this patient meets every criterion. The collar-only answer is the hard call, and many crews reach for it out of habit, but a collar is not risk-free and the criteria for applying one are exactly the assessment that has already been performed. Routine long-board use has largely been abandoned because the board causes pain and pressure injury with no demonstrated benefit, and a vacuum mattress is a gentler device but still restriction this assessment does not call for. These criteria differ between states and services, so the local protocol governs.

A patient has an open abdominal wound with a loop of bowel protruding. How should the EMT dress this evisceration?

• a.Replace the bowel gently into the abdomen and cover the wound with a dry bulky dressing
• b.Cover the organs with a dry sterile gauze and tape it firmly on all four sides
• c.Pack sterile gauze around the loop of bowel to hold it steady during transport
• d.Cover the organs with a moist sterile dressing and then an occlusive outer layer✓

Exposed abdominal contents are covered with a sterile dressing moistened with sterile saline and then an occlusive layer to slow drying and heat loss, and the patient's knees are usually flexed to reduce tension on the wound. The dry sterile dressing is the plausible near-miss, since dry sterile gauze is right for almost every other open wound, but here it lets the bowel dry out and adhere to the dressing. Protruding organs are never pushed back inside, because doing so contaminates the abdominal cavity, and packing gauze around the loop adds pressure without protecting it.

A finger has been completely amputated in a workshop. How should the amputated part be handled for transport?

• a.Wrap the part in sterile gauze, seal it in a dry plastic bag, and keep the bag cool on ice✓
• b.Immerse the part in sterile saline in a sealed jar and keep the jar at room temperature
• c.Leave the part at the scene and transport the patient, since reattachment is rarely possible
• d.Place the part in a container of ice water so the tissue is cooled as fast as possible

The amputated part is wrapped in a sterile dressing, sealed in a plastic bag, and kept cool by resting that bag on ice — never in direct contact with ice or in ice water, which can freeze and destroy the tissue. Saline immersion is the closest wrong answer, and services differ over whether the dressing is left dry or lightly moistened with sterile saline, but no protocol soaks the part, because immersion makes the tissue swell and macerate. The part always travels with the patient, since the surgical team, not the crew, decides whether reattachment is possible.

A patient has a section of ribs broken in two or more places each, and that segment of chest wall moves inward as the patient inhales. What is this finding called and why is it dangerous?

• a.Paradoxical breathing from spinal injury, because the intercostal muscles are paralyzed
• b.Tension pneumothorax, because air trapped under pressure pushes the segment inward
• c.Flail chest, because the segment reduces the volume of air moved with each breath✓
• d.Subcutaneous emphysema, because air trapped in the tissue makes the chest wall move oddly

A free-floating segment of chest wall that moves opposite to the rest of the chest is a flail segment, and it is dangerous because the underlying lung is bruised and the patient cannot generate an effective tidal volume. Spinal injury does cause paradoxical breathing, which makes it the tempting alternative, but there the whole abdomen rises as the chest falls rather than one rib segment moving on its own. A tension pneumothorax pushes structures away from the injured side, and subcutaneous emphysema is felt as crackling under the skin rather than seen as a moving segment.

A construction worker has a metal fragment impaled in the left eye. How should the EMT manage this injury?

• a.Remove the fragment and irrigate the eye continuously with sterile saline en route
• b.Stabilize the object, cover both eyes, and transport✓
• c.Cover the injured eye with a firm pressure patch and leave the other eye uncovered
• d.Apply a moist dressing over the object alone so the cornea does not dry out during transport

The object is stabilized in place, often with a rigid cup, and both eyes are covered, because the eyes move together and any movement of the uninjured eye moves the injured one. Covering only the injured eye is the near-miss: the dressing is right but the uncovered eye keeps tracking whatever it looks at and drags the injured globe with it. An impaled object is not removed in the field, and pressure on a penetrated globe can force its contents out.

A pregnant woman in her third trimester was involved in a crash and must be transported with spinal motion restriction. What positioning change is required?

• a.Tilt the whole immobilization device to the left, or manually displace the uterus✓
• b.Transport her flat and supine, because spinal restriction rules out any tilt of the device
• c.Transport her sitting fully upright so the weight of the uterus is carried by the pelvis
• d.Transport her on her right side so the liver supports the weight of the uterus

Lying flat lets the uterus compress the inferior vena cava and cut venous return, so the entire secured device is tilted toward the patient's left, or the uterus is manually displaced to the left, which preserves spinal alignment while relieving the compression. Keeping her flat and supine is the tempting answer, since tilting a secured patient feels like breaking spinal precautions, but tilting the whole device moves the patient as a unit and does not. Sitting upright does not maintain spinal precautions, and a right-side tilt leaves the uterus over the vena cava, which is the position being avoided.

A 6-year-old fell from a height and has a normal blood pressure with a heart rate of 150 and delayed capillary refill. How should the EMT interpret these findings?

• a.The normal blood pressure shows perfusion is adequate and the child is stable
• b.The heart rate is a normal response to fear and does not indicate any blood loss
• c.The child is in cardiogenic shock, since blunt trauma commonly bruises the heart
• d.The child is in compensated shock and can decompensate very suddenly✓

Children hold their blood pressure up by raising the heart rate and clamping down peripheral vessels, so a normal pressure with tachycardia and delayed capillary refill is compensated shock — and when that compensation fails the pressure falls abruptly. Fear is the reasonable competing explanation for a heart rate of 150 in a frightened child, but fear does not delay capillary refill, so the two findings together cannot be dismissed as distress. Treating the normal pressure as reassurance is the classic pediatric trauma error, and cardiogenic shock is uncommon in children after blunt trauma.

Which mechanism of injury should most strongly raise an EMT's suspicion of severe internal injury even when the patient looks well?

• a.Ejection from a vehicle during a rollover collision✓
• b.A rear-end collision at low speed with no damage to either vehicle
• c.A fall from a standing height onto a carpeted floor indoors
• d.Deployment of the driver's airbag in a frontal collision

Ejection means the occupant absorbed the full energy of the crash and then a second impact on landing, and it remains one of the strongest single predictors of serious injury however well the patient looks. Airbag deployment is the tempting answer: it does show the crash was hard enough to trip the sensor, but the bag absorbed energy rather than delivering it, and deployment by itself is not one of the high-risk mechanism criteria, whereas ejection, compartment intrusion and the death of another occupant are. A low-speed rear-end collision with no vehicle damage and a fall from standing height onto carpet transmit far less energy, although a same-level fall can still be serious in an older adult.

An adult has a large open wound to the side of the neck with dark blood flowing steadily. Besides controlling the bleeding, what specific risk requires an occlusive dressing?

• a.Bacterial contamination of the wound from the surrounding skin and clothing
• b.Swelling of the tissue that compresses the trachea from the outside
• c.Evaporation of fluid from the exposed tissue causing rapid heat loss
• d.Air being drawn into an open vein and forming an air embolism in the heart✓

An open neck vein can draw air in with each breath and send an air embolism to the heart, so the wound is covered with a dressing sealed on all sides and pressure is applied without compressing both carotid arteries. Contamination, heat loss and airway-compressing swelling are all real concerns with neck wounds, which is why they read as plausible, but none of them is a reason the dressing has to be airtight rather than simply absorbent.

A patient's tooth was knocked completely out during an assault and the crew has recovered it. How should the tooth be handled?

• a.Scrub the root clean with sterile gauze and then wrap the tooth in a dry sterile dressing
• b.Place the tooth in tap water so that the root surface is kept from drying out en route
• c.Handle the tooth by the crown and keep it moist, then transport it with the patient✓
• d.Leave the tooth at the scene and have the patient see a dentist within a few days

The tooth is picked up by the crown, kept moist in milk or sterile saline, and sent with the patient, because the living cells on the root surface are what allow reimplantation and they die quickly once dried or scrubbed off. Tap water is the tempting storage medium and it does keep the root wet, but it is hypotonic and bursts those very cells, so it is worse than milk or saline. Delaying dental care by days makes successful reimplantation far less likely.

A patient trapped under a collapsed wall for several hours is about to be freed. Why does the EMT alert the receiving hospital before the weight is lifted?

• a.Because the patient will need pain medication as soon as the pressure is finally released
• b.Because a limb trapped for that long will almost certainly require amputation on arrival
• c.Because releasing the compression can release harmful substances into the circulation✓
• d.Because the injured limb bleeds heavily as soon as circulation is restored to it

Prolonged compression damages muscle, and when the pressure comes off, potassium, myoglobin and acid from that muscle wash into the circulation and can cause cardiac arrest and kidney injury — crush syndrome, which the hospital and advanced providers prepare for in advance. Bleeding on reperfusion is the closest wrong answer, since a crushed limb can indeed bleed once flow returns, but the danger driving the early alert is what enters the bloodstream rather than what leaves the limb. Pain control matters and is not the reason for a pre-arrival notification, and amputation is not a foregone conclusion.

An older adult on an anticoagulant fell and struck her head, and she is alert with no complaints. Why does this patient still warrant transport and careful reassessment?

• a.Anticoagulants cause dizziness that will make a second fall happen within hours
• b.Anticoagulation lets a slow intracranial bleed grow for hours before symptoms appear✓
• c.Older patients cannot give reliable histories, so every fall in this age group is transported
• d.The medication itself must be reversed in the emergency department after any fall

An anticoagulated patient can bleed slowly inside the skull and look entirely normal at first, with deterioration appearing hours later, so a reassuring assessment on scene does not rule out serious injury. The reversal answer is the one that traps prepared candidates: reversal agents do exist, but whether any is given is a hospital decision that depends on imaging and on which anticoagulant was taken, so it is not why this patient is transported. Anticoagulants do not themselves cause dizziness, and many older patients give excellent histories.

Which statement about applying a commercial pelvic binder to a patient with a suspected unstable pelvic fracture is correct?

• a.It is centered over the iliac crests
• b.It is centered over the greater trochanters✓
• c.It is applied only after the pelvis is rocked to confirm instability
• d.It is applied loosely enough to slide a hand underneath the strap

A pelvic binder is centered at the level of the greater trochanters, because that is where circumferential compression actually closes the pelvic ring. Placing it higher, over the iliac crests, is the most common application error in practice and feels anatomically sensible, but a binder sitting on the crests squeezes bone that does not move and leaves the ring unreduced. The pelvis is not rocked or sprung to test for instability, since that can disrupt clot that has already formed, and the binder is snug by design because compression is the whole point.