NREMT EMT — All Questions

Why does a small child's airway obstruct more easily than an adult's?

• a.The child's cricoid cartilage is absent until adolescence, leaving the trachea unsupported
• b.The child's epiglottis is rigid and cannot fold over the glottic opening during swallowing
• c.Breathing depends mainly on the child's intercostal muscles, which tire quickly
• d.The tongue is proportionally larger and the trachea is narrower and more easily compressed✓

A child's tongue takes up proportionally more of the oral cavity, and the trachea is narrower and made of softer cartilage, so a small amount of swelling, a little secretion, or a neck flexed or hyperextended by careless positioning will close it. The epiglottis of a young child is floppier and more omega-shaped than an adult's, not rigid. Infants and small children are largely diaphragmatic breathers — the intercostal muscles are poorly developed, which is why retractions appear so early, but they are not what the child depends on. The cricoid ring is present from birth and is in fact the narrowest point of the airway in a young child, rather than being absent.

An adult is breathing 32 times per minute with very shallow chest movement. Why is this pattern inadequate even though the rate is high?

• a.A fast rate always means the patient is hyperventilating and blowing off carbon dioxide
• b.Much of each shallow breath only fills dead space and never reaches the alveoli✓
• c.Shallow breathing prevents the alveoli from taking up oxygen even when they are filled
• d.Rapid breathing leaves too little time for oxygen to cross the alveolar membrane

Minute volume is tidal volume multiplied by rate, and roughly the first 150 mL of every adult breath only fills the conducting airways — mouth, trachea and bronchi — which take no part in gas exchange. When each breath is barely larger than that anatomic dead space, almost nothing reaches the alveoli no matter how fast the patient breathes, so ventilation is assisted with a bag-valve mask. Diffusion across the alveolar membrane is very fast and is not the limiting step at a rate of 32; the limiting step is that the gas never arrives there. Alveoli that genuinely are filled do take up oxygen normally, and a fast rate on its own does not establish that a patient is hyperventilating.

Two EMTs are ventilating an apneic adult with a bag-valve mask. Why is the two-person technique generally preferred over one person doing both tasks?

• a.One rescuer can hold the mask seal with both hands while the other squeezes the bag✓
• b.It allows a faster ventilation rate to be delivered, which raises the oxygen level sooner
• c.It removes the need to insert an oropharyngeal airway, because the seal alone opens it
• d.One rescuer can apply cricoid pressure, which reliably prevents gastric inflation

A leaking mask is the most common reason bag-valve ventilation fails, and a two-handed seal with a second rescuer squeezing the bag delivers far more of each breath to the patient. An airway adjunct is still needed, since a mask seal does nothing to lift the tongue off the posterior pharynx. Ventilating faster is harmful rather than helpful. Cricoid pressure is what a well-prepared candidate has to weigh against the seal, and it is the weaker choice: routine cricoid pressure is no longer recommended during bag-valve-mask ventilation, it does not reliably prevent air from entering the stomach, and it can obstruct the airway — so freeing a hand for it is not the reason two rescuers are better.

During bag-valve-mask ventilation of an unresponsive adult, the abdomen is becoming visibly distended. What is the most likely cause and the correct correction?

• a.The distention is expected during positive-pressure ventilation and is relieved by pressing on the upper abdomen
• b.The mask seal is leaking, so each breath is squeezed harder to make up the lost volume
• c.The oropharyngeal airway is too long, so it is removed and ventilation continues without it
• d.Ventilations are too fast or too forceful, so they are slowed and each breath made smaller✓

Gastric distention during bag-valve ventilation usually means air is being pushed in faster or harder than the airway will accept, so the pressure rises above what the esophagus will hold shut. The correction is to deliver each breath more slowly, over about one second, and only until the chest visibly rises, while confirming the head position and the airway adjunct. Distention pushes the diaphragm up, makes ventilation harder, and invites regurgitation. Squeezing harder to compensate for a leak is the tempting wrong move — it raises airway pressure and worsens the distention, when the fix is to improve the seal. Pressing on the abdomen to expel the air is not done, because it forces stomach contents into the pharynx. An adjunct that is too long causes gagging or laryngospasm rather than gastric filling.

An unresponsive adult who has a permanent tracheostomy stoma following a total laryngectomy is not breathing. A tracheostomy tube is in place. How should the EMT ventilate this patient?

• a.Insert an oropharyngeal airway and ventilate through the mouth, since the upper airway still connects to the trachea
• b.Ventilate through the mouth and nose while an assistant seals the stoma with a gloved hand
• c.Remove the tracheostomy tube first, because the tube blocks air entering through the stoma
• d.Ventilate through the stoma, using the tracheostomy tube or a mask sealed over it✓

After a total laryngectomy the stoma is the only route to the lungs — the mouth and nose no longer connect to the trachea — so the bag is attached directly to the tracheostomy tube, or an infant or child mask is sealed over the stoma if no tube is present. Ventilating through the mouth and nose while an assistant occludes the stoma is the technique for a partial laryngectomy, where an upper connection still exists; it is a defensible-looking choice and the reason the history matters. An oropharyngeal airway achieves nothing in a patient with no connection between mouth and trachea. The tracheostomy tube is the airway, so it is suctioned rather than removed, and it is removed only if it is obstructed and local protocol permits an EMT to do so.

An EMT is about to suction thick secretions from an unresponsive adult's mouth with a rigid catheter. How is the insertion depth determined?

• a.Insert until resistance is felt so the catheter reaches the secretions at the back of the throat
• b.Insert no further than you can see, measuring from the corner of the mouth to the earlobe✓
• c.Insert until the tip touches the back of the throat, then withdraw slightly before suctioning
• d.Insert to a depth equal to the distance from the tip of the nose to the earlobe, then suction

A rigid (Yankauer) catheter is measured from the corner of the mouth to the earlobe and inserted only as far as the EMT can actually see, because deeper insertion stimulates the vagus nerve and can slow the heart, and can also provoke gagging and vomiting in a patient who cannot protect the airway. Advancing until resistance is felt, or deliberately touching the back of the throat, is how the soft tissue of the pharynx gets torn. Nose-to-earlobe is the measurement for a nasopharyngeal airway, not for a suction catheter. Suction is applied while withdrawing, not on the way in, and most EMS protocols cap a single adult suctioning attempt at roughly 10 to 15 seconds, with the exact limit set locally.

An EMT is checking a portable oxygen cylinder before a shift. Which practice is correct?

• a.Lubricate the regulator threads with a light oil each month so the fitting seats without cross-threading
• b.Keep oil and grease away from the valve and regulator, and change the cylinder before it empties✓
• c.Use the cylinder down to zero, since the regulator will stop the flow when it is empty
• d.Open the cylinder valve with the outlet pointed toward you so the gauge can be watched as it pressurizes

Two rules govern oxygen cylinders. No petroleum product — oil, grease or a petroleum-based lubricant — ever touches an oxygen valve, regulator or fitting, because oil in contact with high-pressure oxygen can ignite, so lubricating the threads is exactly the wrong maintenance habit. And the cylinder is swapped while a usable reserve pressure still remains, since running it to zero leaves nothing for the patient at the worst possible moment and can allow contaminants to be drawn into an empty cylinder. The valve is always cracked open with the outlet directed away from yourself, the patient and any bystanders, because a damaged seat or regulator can release gas violently.

A conscious adult in severe respiratory distress from pulmonary edema is alert and able to follow commands. Where local protocol permits an EMT to apply CPAP, which finding would make CPAP inappropriate?

• a.A respiratory rate of 32 with audible crackles heard throughout both lung fields
• b.A blood pressure of 168/96 and a heart rate of 120 with obvious anxiety
• c.A history of congestive heart failure with three pillows used to sleep at night
• d.A deteriorating level of consciousness with an inability to protect the airway✓

CPAP requires a patient awake enough to follow instructions, keep the mask on, and protect their own airway, so a falling level of consciousness is a contraindication and that patient is ventilated with a bag-valve mask instead. The vital signs are the option worth pausing over: hypotension is the other common contraindication, because the raised pressure inside the chest reduces venous return — but 168/96 is high, not low, and a hypertensive, anxious, tachycardic patient is the typical presentation of the flash pulmonary edema CPAP is meant for. A fast rate with crackles and a pillow-orthopnea history likewise describe the intended patient rather than a reason to withhold it. Whether an EMT may apply CPAP at all is set by state scope of practice and local protocol.

A firefighter pulled from a structure fire has a pulse oximeter reading of 99 percent but is confused and has a headache. How should the EMT interpret the reading?

• a.The reading is falsely high because the patient is breathing rapidly after the exertion
• b.The reading is accurate, so the confusion must have a cause unrelated to any inhaled gas
• c.The reading is unreliable, because the device cannot distinguish carbon monoxide from oxygen✓
• d.The reading rules out carbon monoxide, because carboxyhemoglobin would have driven the number down

A standard pulse oximeter reads carboxyhemoglobin as though it were oxygenated hemoglobin, so a poisoned patient can show a reassuring or even a high number while the blood is carrying very little usable oxygen. That is also why the reading cannot be used to rule carbon monoxide out — the number does not fall, which is the trap in a fire scene with a confused, headachy patient. Treatment is driven by the history and the symptoms: remove the patient from the source and give high-flow oxygen by nonrebreather; a CO-oximeter is what actually measures carboxyhemoglobin. Poor perfusion, cold fingers, motion and nail polish are other causes of unreliable readings, but exertion and a fast respiratory rate do not create a falsely high saturation.

An adult who was choking becomes unresponsive and slides to the floor. What should the EMT do next?

• a.Continue abdominal thrusts with the patient supine until the object is expelled
• b.Perform a blind finger sweep of the mouth to remove the object before anything else
• c.Begin chest compressions, and look in the mouth each time before giving a breath✓
• d.Deliver five back blows between the shoulder blades with the patient rolled onto one side

Once a choking adult becomes unresponsive the sequence changes to CPR beginning with chest compressions, and the mouth is inspected each time the airway is opened for a breath so that a visible object can be removed with the fingers. The compressions themselves generate the intrathoracic pressure that may dislodge the obstruction. A blind finger sweep — reaching in when nothing can be seen — can push the object deeper and is not performed. Abdominal thrusts belong to the still-responsive patient, and while some conscious-choking protocols include back blows, neither manoeuvre is used once the adult is unresponsive and on the ground.

A 6-month-old infant is choking on a piece of food, is conscious, and cannot cry or cough. What is the correct technique?

• a.Abdominal thrusts delivered with two fingers just above the navel, repeated until it clears
• b.Chest compressions at the same rate used for CPR while holding the infant face up on a forearm
• c.A finger sweep of the mouth followed by two rescue breaths, repeated until the chest rises
• d.Five back blows followed by five chest thrusts, repeated while the infant stays conscious✓

A conscious choking infant receives repeated cycles of five back blows and five chest thrusts. Abdominal thrusts are not used at this age because the liver sits low and largely unprotected below the rib margin and is easily injured. A blind finger sweep can drive the object further in and is not performed at any age. Chest compressions are the technique once the infant becomes unresponsive, not while the infant is still awake, and rescue breaths are not given to a conscious infant.

Why is ventilating an apneic patient too rapidly harmful rather than simply unnecessary?

• a.It raises pressure in the chest, which reduces blood returning to the heart✓
• b.It exhausts the oxygen cylinder faster than the patient's transport time will allow
• c.It washes out so much carbon dioxide that the patient stops breathing spontaneously
• d.It produces a respiratory alkalosis, which is the main danger of ventilating too quickly

Each positive-pressure breath raises the pressure inside the chest, and delivering breaths too often leaves no time for that pressure to fall between them, so venous return falls and cardiac output with it — a particular danger during cardiac arrest, where perfusion depends on compressions filling a heart that must first be able to fill. Excess ventilation also forces air into the stomach. Respiratory alkalosis attracts candidates who have studied blood gases, and blowing off carbon dioxide does shift the blood that way, but in a rescuer-ventilated apneic patient the hemodynamic collapse is the harm that kills first. An apneic patient has no spontaneous drive left to suppress, and cylinder duration is a logistical concern rather than the physiological harm.

A patient is receiving oxygen by simple face mask. Why must the flow rate be kept above a minimum level with this device?

• a.To flush exhaled carbon dioxide out of the mask so it is not rebreathed✓
• b.To keep the reservoir bag on the mask from collapsing during each inhalation
• c.To prevent the oxygen from drying the mucous membranes of the nose and mouth
• d.To hold the one-way exhalation valves on the sides of the mask open during exhalation

A simple face mask holds a volume of exhaled gas against the face, so the flow has to be high enough to wash that carbon dioxide out between breaths; too low a flow means the patient rebreathes it, which is why a simple mask is generally run at no less than about 6 L/min. A simple mask has no reservoir bag — that is what distinguishes it from a nonrebreather — and it has no one-way valves either; its side ports are open holes. Drying of the mucous membranes is a real complaint on prolonged oxygen therapy, but it is managed with humidification rather than by raising the flow.

A two-year-old with respiratory distress becomes frightened and fights the oxygen mask, crying and pushing it away. What is the best approach?

• a.Hold the mask firmly against the child's face until the crying settles and it is accepted
• b.Use blow-by oxygen held near the face, often with a parent holding the tubing✓
• c.Withhold oxygen until the child settles, since agitation raises oxygen demand more than the mask helps
• d.Switch to a nasal cannula and tape the prongs in place so the child cannot pull them out

Fighting a mask increases a child's work of breathing and oxygen demand, so oxygen is delivered blow-by — tubing, a mask, or oxygen through a cup held a short distance from the face, ideally by the parent, whose presence children tolerate far better than a stranger's hands. The observation that agitation raises oxygen demand is correct, which makes withholding oxygen the tempting wrong answer; the conclusion does not follow, because blow-by keeps the oxygen flowing without the struggle rather than forcing a choice between the two. Forcing the mask is counterproductive, and taping a cannula in place provokes the same fight.

Which finding best distinguishes adequate breathing from inadequate breathing in an adult?

• a.Equal chest rise with an adequate depth, a normal rate, and speech in full sentences✓
• b.The absence of any audible wheezing or crackles when the chest is auscultated
• c.A respiratory rate that falls anywhere inside the normal published range for adults
• d.A pulse oximetry reading above ninety-four percent while the patient is on room air

Adequacy is judged on rate, depth and effort together — even chest rise, enough tidal volume to move air past the dead space, and the ability to speak a full sentence without pausing for breath. A rate inside the normal range is the closest competing answer and the reason shallow breathing is so often missed: it says nothing about depth, and a patient at 16 breaths a minute can be ventilating inadequately. Clear lung sounds and a reassuring oximetry number can both accompany failing ventilation, the oximetry reading most dangerously in carbon monoxide poisoning.

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.

During a mass-casualty incident run under a typical triage protocol, a patient tagged Immediate at initial triage is reassessed twenty minutes later and is now walking and talking normally. What should happen?

• a.The original tag stands until a physician changes it in hospital
• b.The patient is directed to the minor treatment area with the tag unchanged
• c.The patient is retriaged and the tag changed to the current category✓
• d.The patient is transported immediately in the order the first tag set

Triage is repeated as conditions change, and a patient's category is revised in either direction whenever reassessment shows a different status — that is exactly what secondary triage is for. Moving the patient to the minor treatment area while leaving the old tag in place is the closest wrong answer, because the destination is right, but an Immediate tag on a walking patient misinforms everyone downstream who reads it. A tag records a judgement at one moment rather than a permanent classification, and no physician's authorisation is needed to update it on scene. Transporting on an outdated tag sends scarce resources to the wrong patient, which is what triage exists to prevent.

How does a Good Samaritan law generally differ from an EMT's duty to act while on shift?

• a.It removes all liability from any provider who renders aid, on duty or off duty
• b.It offers limited protection to someone who volunteers aid without a duty to act✓
• c.It applies only to physicians and nurses, not to certified EMTs or paramedics
• d.It requires every certified provider to stop and render aid at any emergency scene

Good Samaritan statutes exist to encourage bystanders, including off-duty providers in many states, to help by limiting liability for care given in good faith and without compensation; they do not create an obligation to stop. The blanket-immunity answer is the tempting one, because these laws really are protective, but the protection is limited and none of them shields gross negligence or wilful misconduct. An on-duty EMT dispatched to a call has a duty to act, which is a separate legal concept, and coverage is not restricted to physicians and nurses. The details vary considerably between states.

A crew is asked to set up a landing zone for a medical helicopter at a rural crash. Which requirement is correct?

• a.An area directly beside the wreckage so that the transfer distance to the aircraft is as short as possible
• b.A paved surface only, because the rotor wash lifts dust and gravel from unpaved ground
• c.An area marked with road flares at each corner so the pilot can identify it from the air
• d.A level, firm area clear of wires, poles, and loose debris, sized as the flight crew specifies✓

The landing zone must be level, firm, and free of overhead wires, poles, trees and anything the rotor wash could pick up, and the flight crew specifies the dimensions they need for the aircraft they are flying. Marking the corners is genuinely part of setting up a zone, which is what makes the flare answer plausible, but open flame can be blown into the aircraft or ignite spilled fuel, so cones or secured lights are used instead. Dust and debris are managed by choosing and wetting the surface rather than by demanding pavement that rural scenes rarely offer, and the zone is kept well away from the wreckage.