EMR Practice Quiz

Correct! The Emergency Medical Responder Course is 80-120 hours and constitutes the first national standard of pre-hospital care. This is followed by Primary Care Paramedic (6 months – 2 years in length), Advanced Care Paramedic (1 – 2 years in length) and Critical Care Paramedic (1 – 2 years in length).

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Correct!  The mechanism of injury allows you to suspect potential injuries your patient may have.

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Correct!  You must survey the scene to determine if any hazards are present, to determine what the environment is, to determine the mechanism of injury, to determine how many patients there are, and to determine what additional resources you might need.

Correct!  once you have completed your scene survey you should proceed to the Primary Survey, beginning by assessing the patient’s LOC using AVPU.

Correct!  LOC DABC RBS Skin O2!

Correct!  The head tilt chin lift should be used.

Correct!  This patient should be under spinal precautions, therefore you would use the jaw thrust technique to open the airway.

Correct!   Fluid should be rapidly suctioned out of the patient’s airway.  If the patient’s mouth was full of “chunky” fluid you would need to roll the patient lateral and finger sweep the “chunks” out.

Correct!  You should only  suction the visible oral pharynx.  Only suction what you can see.

Correct!  You should suction the patient until the fluid is removed.

Correct!  If the patient responds to verbal stimuli they most likely still have their own gag reflex.

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Correct!  This patient still has a gag reflex, but also still has a decreased level of consciousness.  This patient’s LOC may deteriorate further, at which time they will lose their gag reflex and their airway protective mechanisms.

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Correct!  The main trigger to breath in a health person’s body is when low levels of carbon dioxide are present.

Correct!  It is important to determine if the patient’s breathing rate is effective (not too fast or slow), and if the quality is adequate (is there a sufficient volume of air entering the lungs with each breath).

Correct!  This patient needs ventilated with high flow O2.

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Correct!  The carotid pulse is usually the last pulse a person will lose prior to cardiac arrest.  When the adult patient is unconscious we need to know immediately if they require ABC interventions, therefore we use this pulse.  When the adult patient is conscious, however, we can use their radial pulse which is usually more accessible, and also tells us more about the status of their circulatory system.  These are often difficult pulses to find on a baby, however, so we use the brachial pulse for babies.

Correct!  Though cardiac arrest patients may initially display short “gasping” breaths called agonal respirations, these will quickly cease.  Do not mistake these for organized respirations.  If the patient is unconscious with no carotid pulse (adults and children) or brachial pulse (babies) begin CPR.

Correct!  One Rescuer CPR for all ages is 30:2.

Correct!  Two Rescuer CPR on an adult is 30:2, but for all children and infants it is 15:2.

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Correct!  The AED should be placed beside the compressor, who can more easily operate it without reaching across the patient.

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Correct!  The two most important things for a cardiac arrest patient are high quality CPR and timely defibrillation.  Stopping constantly to re-assess the pulse delays these things.  Once you have started the resuscitation you should only stop to re-assess the pulse if the patient shows signs of life (i.e. spontaneous breathing, movement, etc).

Correct!  It is important to reduce any time off the patient’s chest.  Once a shock is delivered, or as soon as the AED messages “no shock advised”, you should immediately return to chest compressions.  The only time you should re-assess the pulse is if the patient shows signs of life.

Correct! The two most important interventions in a cardiac arrest are chest compressions and rapid defibrillation. This requires both you and your partner in the back of the ambulance. Continuing on with one rescuer CPR while your partner drives delays the application of the AED, and chest compressions in the back of a moving vehicle are never as effective as when you are stationary.

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Correct!  Most bleeding can be controlled with firm direct pressure applied over the wound (with sterile gauze if available).

Correct!  You never want to remove the original layer as it may disturb the wound and any clots that have formed.  Apply additional gauze on top and more direct pressure.

Correct!  The best time to apply a tourniquet is if two attempts at direct pressure fail to control the bleed.

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Correct!  Shock, by definition, is inadequate tissue perfusion.  This means inadequate blood flow to the cells of the body.

Correct!    The first thing is to treat the immediate cause of shock if you are able to do so (i.e.  controlling life threatening bleeding).  You can also aid the patient by keeping them supine (reducing the workload on the circulatory system by removing gravity), keeping them warm and comfortable, and providing nothing to drink.   Ultimately the most important thing for the patient in shock is rapid transport to the hospital to correct the underlying cause of shock.

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Correct!  All unconscious patients should be placed 3/4 because it provides maximal (along with other airway adjuncts as required) airway protection… pulling the tongue forward and providing an avenue for fluid to drain out.  Spinal patients are usually best managed supine, however, and the unconscious patient will also need to be supine to be ventilated or to have CPR performed on them.

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Correct!  Eyes opening to pain is a 2, no verbal sounds is a 1, and withdrawing from pain is a 4.  This patient’s GCS is 7.

Correct!  The contractile phase is called systolic phase of a heart beat.  This is the top number measured when assessing blood pressure.  When the heart relaxes between beats it is called the diastolic phase.  This is the bottom number on a blood pressure reading.

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In order for an EMR to administer nitroglycerin to a patient with chest pain the following conditions must be present:

1) The patient must have chest pain suggestive of cardiac origin.

2) The patient must have a history of nitroglycerin use.

3) The EMR must have completed the primary survey, applied O2, initiated transport, completed a history / baseline set of vital signs, and ruled out Viagra/Levitra use in the last 24 hours or Cialis use in the last 48 hours.

4) The patient’s systolic blood pressure must be > 100mm/Hg.

Correct!  Nitroglycerin is a vasodilator.  Vasodilation reduces blood flow to the heart (the blood “pools” in the enlarged vessels), which means the heart doesn’t have to work as hard.  The vasodilation also potentially increases blood flow through the narrowed coronary arteries.

Correct, Entonox is an appropriate choice if all of the contraindications have been ruled out.

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Correct!  Battle Signs are bruises found behind the ears, typically indicative of a skull fracture.

Correct!  A flail chest occurs when a segment of the rib cage becomes detached from the rest of the chest wall.  This causes the flail segment to move independently from the rib cage, increasing pain, work of breathing and soft tissue damage.  This can cause pulmonary contusions, causing accumulations of fluids in the lung tissue.  This accumulated fluid interferes with gas exchange, leading to hypoxia.

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Correct!  Because the fracture is closed and mid third you can apply 10% of the patient’s body weight to a maximum of 15 pounds of traction.

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Correct!  Patients who have rapidly progressed to heat stroke have usually sweated out available fluid, so their skin becomes Hot, red and dry as they become more dehydrated and their core temperature rises.

Correct!  The patient needs to be rapidly removed from the hot environment, the ABCs need managed, and the patient needs rapidly cooled.

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Correct!  Croup is a viral infection that often starts with a cold and low grade fever, then progresses to shortness of breath and the “seal bark” cough that is often heard.