You are dispatched to a reported fight outside a bar. From the ambulance you can see two people still shouting, and one person on the curb with blood on a sleeve. What do you do first?
Choose the one best answer.
Correct. You do not approach until the scene is safe. Treatment starts after you can reach the person without being hurt.
Wrong. The bleeding matters, but an argument that is still going is not a secure scene. You become a patient if you walk into it.
Wrong. The weapon is useful history. It is not the first action while people are still fighting.
Wrong. Airway care is a primary-assessment skill. You cannot start it from inside an unsecured fight.
Scene size-up and safety
A car has hit a pole. A power line is lying across the roof and the driver is calling for help. What is the correct action?
Choose the one best answer.
Wrong. Oxygen may be appropriate after you can safely reach the driver. It is not a reason to enter the energized area.
Wrong. History and vital signs come after the scene is safe and life threats are being managed. The line is still the first problem.
Correct. Your first job is to keep the scene from gaining more patients. Do not approach, and do not have the driver exit, until the line is confirmed dead.
Wrong. Extrication and spinal motion restriction are the right next care, after the line is dead. Doing them now puts you on an energized car.
Scene size-up and safety
For each action, decide whether it is part of scene size-up.
Select one choice in each row. This item is correct only if every row is right.
Part of scene size-up
Not part of scene size-up
Look for traffic and other hazards before you approach
Ask what medications the patient takes
Decide whether you need another unit
Listen to lung sounds in all lobes
Correct: Part of scene size-up. Hazard identification is the start of scene size-up, before patient contact.
Correct: Not part of scene size-up. Medications are the M in SAMPLE. That history is taken after life threats are being managed.
Correct: Part of scene size-up. Calling for more help is part of size-up, once you know the number of patients and the hazard.
Correct: Not part of scene size-up. Lung sounds are a patient exam. They are not done from the ambulance during size-up.
Primary assessment
A 54-year-old is unresponsive on a couch. Bystanders report no trauma. You hear snoring. What is the first airway action?
Choose the one best answer.
Wrong. SAMPLE is useful and comes later. Snoring is an airway problem now.
Wrong. Oxygen is appropriate after the airway is open. It does not move the tongue.
Correct. With no trauma, a head-tilt chin-lift lifts the tongue off the posterior pharynx. That is the first airway move.
Wrong. An oropharyngeal airway is a reasonable adjunct after the airway is opened manually, and only if there is no gag. It is not the first move.
Primary assessment
An unresponsive driver is snoring after a high-speed crash. The windshield is starred in front of the driver. How do you open the airway?
Choose the one best answer.
Wrong. Oxygen is the right support after the airway is open. It does not stop the snoring.
Wrong. Looking at the back is a later exam. Open the airway before you roll for a secondary look.
Wrong. A collar is part of spinal motion restriction and comes after the airway is open. The snoring is the immediate problem.
Correct. The jaw thrust opens the airway and keeps the neck in line. Use it when spine injury is suspected.
Primary assessment
An unresponsive patient has blood and vomit in the mouth and you hear gurgling. What do you do before you ventilate?
Choose the one best answer.
Correct. Suction first. Limit an adult suction attempt to about 15 seconds so you do not cause hypoxia, then ventilate.
Wrong. Vital signs belong in the secondary assessment. Gurgling is a primary-assessment problem.
Wrong. Ventilation is the right next step after the airway is clear. Doing it first pushes blood and vomit into the lungs.
Wrong. Oxygen helps after the patient can actually move air. It does not remove the liquid.
Primary assessment
A patient was stabbed in the thigh. Bright red blood is pulsing from the wound and direct pressure has not stopped it. What do you do next?
Choose the one best answer.
Wrong. A detailed exam waits. Pulsing blood is a life threat now.
Wrong. A splint does not stop arterial bleeding.
Correct. Place it above the wound, tighten until the bleeding stops, and note the time. Do not remove it in the field.
Wrong. SAMPLE is secondary-assessment history. It does not come before bleeding control.
Primary assessment
An adult is unresponsive, is not breathing, and you do not definitely feel a pulse within 10 seconds. What do you do?
Choose the one best answer.
Correct. Start CPR. Adult compressions are 100 to 120 per minute and about 2 inches deep. Use an AED as soon as it arrives.
Wrong. The AED is used as soon as it is available, but you do not stand and wait to start compressions.
Wrong. Two breaths can follow the first cycle of compressions. Compressions come first when there is no pulse.
Wrong. Blood pressure and SAMPLE are later. There is no definite pulse, so compressions start now.
Primary assessment
An adult has a definite pulse. Breathing is 6 times a minute and shallow. How do you ventilate?
Choose the one best answer.
Wrong. A nonrebreather is reasonable when the patient is breathing adequately but hypoxic. Six shallow breaths a minute need ventilation, not just oxygen.
Correct. That is about 10 breaths a minute. Each breath should make the chest rise. Recheck the pulse so you notice if it disappears.
Wrong. Compressions are for no pulse. This patient has a definite pulse, so ventilation is the treatment.
Wrong. Glucose and SAMPLE matter and come after breathing is supported.
Primary assessment
Which findings mean breathing is inadequate? Select every finding that applies.
Select all that apply. This item is correct only if every selection is right.
Correct. Tidal volume is too small. The patient is not moving enough air.
Correct. Eight breaths a minute is too slow for an adult to ventilate adequately.
Wrong. Pink, warm, dry skin is a perfusion finding, not a sign of inadequate breathing.
Wrong. Full sentences mean the patient is moving enough air to talk. That is adequate breathing.
Correct. Neck and other accessory muscles mean the work of breathing has failed the usual muscles.
Primary assessment
Place each finding in the assessment where it belongs.
Place every finding. This item is correct only if every finding is in the right column.
Spurting blood from the wrist
Correct column: Deal with it in the primary assessment. Arterial bleeding is a life threat. Control it in the primary assessment.
A SAMPLE history
Correct column: Leave it for the secondary assessment. SAMPLE is history. Take it once life threats are being managed.
No chest rise
Correct column: Deal with it in the primary assessment. Absent breathing is a primary-assessment emergency. Open the airway and ventilate.
An OPQRST pain history
Correct column: Leave it for the secondary assessment. OPQRST describes a symptom. It is not how you find a life threat.
Secondary assessment
Which task belongs in the secondary assessment, not the primary?
Choose the one best answer.
Wrong. Life-threatening bleeding is handled in the primary assessment.
Correct. SAMPLE is the history gathered in the secondary assessment, after life threats are being managed.
Wrong. Level of responsiveness is part of the primary assessment, not a later history step.
Wrong. Chest rise is the breathing check in the primary assessment.
Secondary assessment
A patient has chest pain. Which question is the Onset part of OPQRST?
Choose the one best answer.
Wrong. That is Provocation or palliation, not onset.
Wrong. That is Severity.
Wrong. That is Radiation.
Correct. Onset is what the patient was doing when it began, and whether it started suddenly or gradually.
Patient treatment and transport
A conscious adult was stung by a bee, has a known allergy, has hives and wheezing, and carries a prescribed epinephrine auto-injector. What should you do?
Choose the one best answer.
Wrong. Vital signs and SAMPLE come after epinephrine. Fading hives do not replace the injection or the trip.
Wrong. Rechecking after epinephrine and during transport is right. Waiting 20 minutes with water, and no epinephrine, is how anaphylaxis worsens.
Wrong. Aspirin is a later consideration for chest pain, not for anaphylaxis, and walking a wheezing patient is the wrong order.
Correct. Intramuscular epinephrine in the anterolateral thigh is the treatment. Transport anyway, because the reaction can return.
Patient treatment and transport
Arrange the steps for assisting with a prescribed epinephrine auto-injector.
Put every step in the order you would do it. This item is correct only if the whole list is right.
Steps still to place
Your order
Step 1, correct. Confirm it is the patient's epinephrine and the injector is not expired. Right drug and a usable injector come first. An expired or wrong device does not get injected.
Step 2, correct. Take off the safety cap. The cap comes off after you know it is the right drug, and before the tip touches the thigh.
Step 3, correct. Press the tip into the outer mid-thigh until it activates. The anterolateral thigh is the site. Do this only after the drug is confirmed and the cap is off.
Step 4, correct. Reassess breathing and prepare to transport. Epinephrine is not the end of care. Breathing can still fail, and the patient goes to the hospital.
Patient treatment and transport
An alert adult has squeezing chest pain, is not allergic to aspirin, and has no recent bleeding. Your protocol allows aspirin. What do you do?
Choose the one best answer.
Wrong. More history is useful. It should not delay protocol aspirin when allergy and bleeding are already ruled out.
Correct. No allergy and no recent bleeding are the usual reasons this patient can receive aspirin under protocol.
Wrong. That is a real nitroglycerin sequence for a patient who qualifies. This patient already qualifies for aspirin. Nitroglycerin is not repeated every minute until the pain is gone.
Wrong. Aspirin may still be indicated. Walking comes never, and it is not a test that replaces the dose.
Patient treatment and transport
An adult twisted an ankle, is speaking in full sentences, and has an oxygen saturation of 99 percent on room air. What oxygen treatment is appropriate?
Choose the one best answer.
Wrong. A secondary exam is reasonable. It is not a reason to put this patient on oxygen, and a 12-lead is not indicated by a twisted ankle.
Wrong. Splinting is appropriate later for this injury. Oxygen is not needed at all with normal speech and a saturation of 99 percent.
Wrong. High-flow oxygen is for hypoxia or inadequate breathing. This patient needs the splint, not the mask.
Correct. Breathing is adequate and the saturation is normal. Oxygen is not indicated.
Operations
You are the first unit at a bus crash. Many people are walking and some are on the ground. The scene is safe. What do you do before a full assessment of one person?
Choose the one best answer.
Wrong. Oxygen and vital signs are right for a sick patient after triage says they go first. Choosing them before the sort skips the immediate patients.
Correct. Walking patients are tagged minor. You then sort the rest by respirations, perfusion, and mental status.
Wrong. More units are part of size-up and should be requested. The scene is already safe, so triage of who cannot walk starts now, not after you wait.
Wrong. Tagging walkers as minor is right. A full exam of the first walker comes after the people who cannot walk have been sorted.
Operations
An adult is alert to person, place, time, and event, understands the risks, and still refuses transport after a minor crash. What do you do?
Choose the one best answer.
Correct. Informed refusal means they heard the risks and the advice to be seen. You record what you said and what they decided.
Wrong. Walking can be part of an exam. It does not replace explaining the risks of refusing transport.
Wrong. A signature documents a refusal. It is not something you collect after you have already taken a person who refused.
Wrong. The exam and vital signs support the decision. The refusal is not informed until the risks are explained.
Operations
You are the first unit at a highway crash with fuel leaking across the lane. What is the right first move?
Choose the one best answer.
Wrong. Vital signs and transport come after people are out of the hazard. The quiet patient may be the sickest, and the spill is still first.
Wrong. Uphill and upwind is the right place to stage. Oxygen is later, and not from inside the fuel.
Correct. The first unit names command, protects people from the hazard, and gets the right help coming.
Wrong. Triage is the right next step after the scene is safe. The fuel is not a safe place to do it.
Original study items. Not an official examination, not affiliated with the National Registry of Emergency Medical Technicians, and not medical advice.