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| Section | Objectives |
|---|---|
| Topic 1: Medical, Obstetrics and Gynecology | - Medical Emergencies
|
| Topic 2: EMS Operations | - Operational Procedures
|
| Topic 3: Airway, Respiration and Ventilation | - Airway Management
|
| Topic 4: Cardiology and Resuscitation | - Cardiac Emergencies
|
| Topic 5: Trauma | - Trauma Assessment and Care
|
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NEW QUESTION # 210
A patient is experiencing acute coronary syndrome but is not hypoxemic. Which of the following results could come from oxygen administration? Select the two answer options that are correct.
Answer: C,D
Explanation:
The correct answers are C. Increased tissue damage and E. Coronary artery vasoconstriction.
In patients with acute coronary syndrome (ACS) who are NOT hypoxemic, routine oxygen administration is no longer recommended because it may actually be harmful.
Key pathophysiology:
1. Coronary Artery Vasoconstriction (E):
High concentrations of oxygen can cause vasoconstriction of coronary arteries, which reduces blood flow to already ischemic heart tissue.
* "Supplemental oxygen in non-hypoxemic patients may cause coronary vasoconstriction."
2. Increased Tissue Damage (C):
Excess oxygen can lead to oxidative stress and worsen ischemic injury, potentially increasing infarct size or tissue damage.
* "Hyperoxia may increase oxidative injury and worsen myocardial damage." Why the other options are incorrect:
* A. Reduced mortality: Evidence does not support mortality benefit in non-hypoxemic ACS patients.
* B. Resolution of chest pain: Oxygen does not reliably relieve ischemic chest pain unless hypoxia is present.
* D. Reduction in infarction size: Studies show no benefit and possible harm.
NREMT/AHA-aligned guidance emphasizes:
* "Administer oxygen only if SpO# is less than 94% or if the patient is hypoxic."
* Routine oxygen in normoxic patients is not recommended and may be harmful.
Exact Extracts (NREMT/AHA-aligned references):
* "Avoid routine oxygen use in patients with normal oxygen saturation."
* "Hyperoxia can cause coronary vasoconstriction."
* "Excess oxygen may worsen myocardial injury."
Clinical Priority Summary:
In non-hypoxemic ACS patients, oxygen can cause harm rather than benefit, specifically vasoconstriction and increased tissue damage, making C and E correct.
References:
NREMT EMT Education Standards - Cardiology & Resuscitation
American Heart Association (AHA) Guidelines for CPR and ECC
NREMT National Continued Competency Program (NCCP)
NEW QUESTION # 211
Which of the following is an acute sign of closed head trauma?
Answer: A
Explanation:
The correct answer is A. Memory loss.
Why A is correct (Memory loss):
Memory loss (amnesia) is a common and immediate (acute) sign of closed head injury, especially in concussions. It may include:
* Retrograde amnesia (loss of memory before the event)
* Anterograde amnesia (inability to form new memories)
NREMT-aligned trauma guidance states:
* "Patients with head injuries may present with confusion or memory loss immediately after the event."
* This is considered an early indicator of brain injury.
Why the other options are incorrect:
* B. Beck ' s Triad: Associated with cardiac tamponade (hypotension, JVD, muffled heart sounds), not head trauma.
* C. Battle ' s sign: Bruising behind the ears indicating a basilar skull fracture, but this is typically a late sign, not acute.
* D. Raccoon eyes: Periorbital ecchymosis also indicating a basilar skull fracture, and similarly a delayed finding, not immediate.
Key Concept:
* Acute signs = occur immediately (e.g., confusion, memory loss, LOC)
* Late signs = develop over time (e.g., Battle's sign, raccoon eyes)
Exact Extracts:
* "Early signs of head injury include confusion, disorientation, and memory loss."
* "Battle's sign and raccoon eyes are late signs of basilar skull fracture."
* "Assessment should identify immediate neurologic changes following trauma." References:
NREMT EMT Education Standards - Trauma (Head and Brain Injuries)
NREMT National Continued Competency Program (NCCP) - Trauma Management
Prehospital Emergency Care (EMT) - Traumatic Brain Injury
NEW QUESTION # 212
A 38-year-old patient is unconscious with slow, shallow, and gasping breaths. The patient is not moving.
What should the EMT perform first?
Answer: D
Explanation:
In any unresponsive patient, the first step is to assess and open the airway to determine patency and identify obstruction or inadequate breathing.
Gasping respirations (agonal) are not effective; they require BVM ventilation support. The airway must be open before checking for a pulse or performing auscultation. A secondary assessment is performed only after primary survey and stabilization.
References:
AHA BLS Provider Manual (2020) - Unresponsive Patient Algorithm
NREMT Airway Skills - Primary Assessment
National EMS Education Standards - Airway, Breathing, Circulation (ABC) Sequence
NEW QUESTION # 213
The AED announces, "Shock advised." You should suspect:
Answer: B
Explanation:
The correct answer is D. Ventricular tachycardia.
When an AED states "shock advised," it means the device has detected a shockable rhythm, which includes:
* Ventricular fibrillation (VF)
* Pulseless ventricular tachycardia (VT)
Among the answer choices, the only shockable rhythm listed is ventricular tachycardia.
Why this is correct:
AEDs are specifically programmed to identify rhythms that benefit from defibrillation. According to NREMT and AHA guidelines:
* "Shockable rhythms include ventricular fibrillation and pulseless ventricular tachycardia." Why the other options are incorrect:
* A. Asystole: This is a non-shockable rhythm (flatline). Treatment is CPR and medications, not defibrillation.
* B. Atrial fibrillation: This is typically a perfusing rhythm and is not treated with AED shocks in cardiac arrest.
* C. Pulseless electrical activity (PEA): Also a non-shockable rhythm; treated with CPR and addressing underlying causes.
Exact Extracts (NREMT-aligned EMT educational references):
* "AEDs will advise a shock only for ventricular fibrillation or pulseless ventricular tachycardia."
* "Asystole and pulseless electrical activity are non-shockable rhythms." Clinical Priority Summary:
A "shock advised" message always indicates a shockable rhythm, and the only correct option given is ventricular tachycardia, making D the correct answer.
References:
NREMT EMT Education Standards - Cardiology & Resuscitation
American Heart Association (AHA) Guidelines for CPR and ECC
NREMT National Continued Competency Program (NCCP)
NEW QUESTION # 214
Which of the following would directly increase public safety in the community?
Answer: C
Explanation:
The correct answer is B because conducting child safety seat clinics has a direct injury-prevention effect in the community. NREMT-aligned EMS operations includes the EMT role in public education and injury prevention , and child passenger safety programs directly reduce the risk of injury and death in motor vehicle crashes by helping caregivers properly restrain children.
This makes it the option that most directly improves community public safety , rather than simply improving visibility or public relations.
NEW QUESTION # 215
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