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| Section | Weight | Objectives |
|---|---|---|
| Patient Treatment and Transport | 20–24% | - Medical and trauma care interventions - Patient packaging and transport procedures - Medication administration and protocols - Communication with receiving facilities |
| Secondary Assessment | 5–9% | - Focused history and physical exam - Symptom assessment and history taking - Vital signs and monitoring |
| Scene Size-Up and Safety | 15–19% | - Mechanism of injury / nature of illness - Hazard recognition and management - Scene assessment and safety protocols |
| Primary Assessment | 39–43% | - Airway, breathing, and circulation management - Identification and management of life-threatening conditions - General patient impression and priority determination - Initial patient assessment |
| EMS Operations | 10–14% | - EMS system roles and responsibilities - Documentation and legal aspects - Incident command and multiple-casualty situations - Emergency vehicle operations and safety |
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問題 #26
A 23-year-old male is pacing and has incomprehensible speech. During your assessment, he throws a chair against the wall. You should next:
答案：B
解題說明：
The correct answer is A. leave the scene.
In EMS, scene safety is the top priority. If a patient becomes violent or poses an immediate threat, the EMT must remove themselves from danger immediately. The situation described-pacing, incomprehensible speech, and throwing a chair-indicates an actively violent and unsafe environment.
Why A is correct:
* The patient is demonstrating violent behavior, creating an unsafe scene.
* NREMT guidelines emphasize that EMTs should not remain in or enter unsafe scenes.
* The correct sequence is to retreat first, then request additional resources such as law enforcement.
Why the other options are incorrect:
* B. Apply soft restraints # Restraints should only be applied when the scene is safe and with adequate personnel, often including law enforcement.
* C. Request Advanced Life Support # ALS does not address immediate scene safety threats.
* D. Request law enforcement # This is appropriate, but only after ensuring your own safety by leaving the scene first.
Exact Extracts:
* "Scene safety is the first priority in patient care."
* "If a scene becomes unsafe, the EMT should retreat to a safe location."
* "Do not attempt to restrain a violent patient unless the scene is secure and adequate help is available." References:
NREMT EMT Education Standards - EMS Operations (Scene Safety)
National EMS Education Standards - Workforce Safety and Wellness
NREMT Candidate Handbook - Patient Assessment and Safety
問題 #27
A 67-year-old patient has a sudden onset of weakness and dizziness after feeling a tearing pain in their chest.
The patient has a history of diabetes, myocardial infarction, and hypertension. Lung sounds are clear. The skin is pale and cool to the touch. The vital signs are BP 88/52, P 128, and R 24. Which of the following types of shock should the EMT most strongly suspect?
答案：B
解題說明：
The correct answer is B. Hypovolemic shock.
Key findings in this scenario:
* Sudden "tearing" chest pain # classic sign of aortic dissection or rupture
* Hypotension (BP 88/52)
* Tachycardia (P 128)
* Pale, cool, clammy skin
* Clear lung sounds
Why this indicates hypovolemic shock:
A tearing chest pain strongly suggests a vascular catastrophe (e.g., aortic dissection/rupture), which can lead to internal bleeding. This results in:
* Loss of circulating blood volume
* Decreased perfusion
* Signs of hypovolemic shock
NREMT-aligned guidance states:
* "Hypovolemic shock results from significant fluid or blood loss."
* "Patients present with hypotension, tachycardia, and cool, pale skin." Why NOT cardiogenic shock (C):
Although the patient has a cardiac history:
* Cardiogenic shock typically presents with:
* Pulmonary edema (crackles)
* Signs of heart pump failure
* This patient has clear lung sounds, which argues against cardiogenic shock Why the other options are incorrect:
* A. PsychogenicCauses temporary fainting, not sustained hypotension with shock signs
* D. SepticUsually presents with warm skin (early) and signs of infection, not tearing chest pain Exact Extracts (NREMT-aligned EMT educational references):
* "Hypovolemic shock is caused by blood or fluid loss."
* "Signs include hypotension, tachycardia, and cool, pale skin."
* "Internal bleeding can result in hypovolemic shock."
Clinical Priority Summary:
The tearing chest pain with hypotension and signs of poor perfusion strongly suggests internal hemorrhage, leading to hypovolemic shock, making B the correct answer.
References:
NREMT EMT Education Standards - Cardiology & Resuscitation
NREMT National Continued Competency Program (NCCP)
AAOS Emergency Care and Transportation of the Sick and Injured (NREMT-aligned)
問題 #28
A 67-year-old patient is unresponsive, and an EMT checks for a pulse prior to applying an AED. Which of the following screenable rhythms, ventricular fibrillation or ventricular tachycardia, if either, may still produce a pulse in this patient?
答案：A
解題說明：
The correct answer is B. Ventricular tachycardia only.
Key Concept: Shockable Rhythms and Pulse Presence
The two primary shockable rhythms are:
* Ventricular fibrillation (VF)
* Ventricular tachycardia (VT)
Ventricular Fibrillation (VF):
* Chaotic, disorganized electrical activity
* No effective cardiac output
* Always pulseless
NREMT-aligned reference:
* "Ventricular fibrillation results in no pulse due to ineffective quivering of the ventricles." Ventricular Tachycardia (VT):
* Rapid, organized ventricular rhythm
* May be:
* Pulseless VT (cardiac arrest)
* Perfusing VT (with a pulse)
NREMT-aligned reference:
* "Ventricular tachycardia may present with or without a pulse."
Why B is correct:
* Only ventricular tachycardia can sometimes produce a pulse
* VF never produces a pulse
Why the other options are incorrect:
* A. VF only # Incorrect; VF is always pulseless
* C. Both # Incorrect; VF cannot produce a pulse
* D. Neither # Incorrect; VT can produce a pulse
Exact Extracts (NREMT/AHA-aligned references):
* "Shockable rhythms include ventricular fibrillation and pulseless ventricular tachycardia."
* "Ventricular tachycardia may be with or without a pulse."
* "Ventricular fibrillation produces no cardiac output."
Clinical Priority Summary:
Among shockable rhythms, only ventricular tachycardia can still produce a pulse, making B 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)
問題 #29
A 38-year-old patient is dyspneic and has facial swelling after eating at a restaurant. What should the EMT do first?
答案：A
解題說明：
The correct answer is C. Administer epinephrine.
This patient is presenting with classic signs of anaphylaxis, a life-threatening allergic reaction:
* Dyspnea (respiratory distress)
* Facial swelling (angioedema)
* Recent exposure to a likely allergen (food)
Why C is correct (Epinephrine):
Epinephrine is the first-line, life-saving treatment for anaphylaxis. It works by:
* Dilating bronchioles (improving breathing)
* Constricting blood vessels (improving blood pressure)
* Reducing airway swelling
NREMT-aligned guidelines state:
* "Administer epinephrine immediately in patients with signs of anaphylaxis."
* "Do not delay epinephrine administration in life-threatening allergic reactions." Why the other options are incorrect:
* A. Provide oxygen: Important, but not the priority over epinephrine in anaphylaxis.
* B. Initiate rapid transport: Necessary, but after immediate life-saving intervention.
* D. Obtain vital signs: Should not delay treatment in a critical patient.
Key Concept:
* In anaphylaxis, epinephrine is the first and most critical intervention.
* Delays in administration significantly increase mortality risk.
Exact Extracts:
* "Epinephrine is the drug of choice for anaphylaxis."
* "Immediate administration is critical in respiratory distress with allergic reactions."
* "Airway swelling and bronchoconstriction must be rapidly treated."
References:
NREMT EMT Education Standards - Medical Emergencies (Allergic Reactions) NREMT National Continued Competency Program (NCCP) - Medical Emergencies Prehospital Emergency Care (EMT) - Allergic Reactions and Anaphylaxis
問題 #30
Calling your medical director for orders to assist with administration of an additional dose of nitroglycerin is an example of
答案：B
解題說明：
This situation describes contacting the medical director directly for patient-specific instructions , which is the definition of on-line medical direction . In national EMS education guidance used by NREMT-aligned programs, EMTs must be able to consult on-line medical direction when needed.
Why B is correct:
When an EMT calls for permission or orders to give an additional dose of nitroglycerin , that is real-time communication with physician oversight. This is on-line medical direction rather than a standing order. The EMS curriculum also explains that medication administration such as nitroglycerin may occur with medical direction approval .
Why the other options are wrong:
A). standard operating protocols - these are standing rules or preapproved procedures followed without calling for a new patient-specific order.
C). evidence-based medicine - this means care guided by research and best evidence, not a phone/radio order from medical control.
D). continuous quality improvement - this refers to reviewing and improving system performance, not obtaining treatment orders during active patient care.
問題 #31
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