You arrive at a house fire. A person is on the lawn, and smoke is still pushing from the front door. What do you do first?
Choose the one best answer.
Wrong. Oxygen and SAMPLE are appropriate after the patient is out of the smoke. They are not a reason to stay beside the doorway.
Wrong. A detailed exam is the secondary assessment. Moving the patient out of the smoke comes first.
Correct. Get the patient out of the smoke first, then assess. Do not go into the building.
Wrong. A search for more patients is right once the structure is cleared. Smoke is still pushing from the door, so the person on the lawn is moved first.
Scene size-up and safety
You are sizing up a highway crash. Which actions belong in that size-up?
Select one choice in each row. This item is correct only if every row is right.
Do this in size-up
Not a size-up action
Park to protect the scene from oncoming traffic
Apply a traction splint before you leave the ambulance
Tell dispatch how many vehicles and patients you can see
Post a photo of the wreck for your personal account
Correct: Do this in size-up. A blocking or fend-off position is how you keep the next car from hitting the crew.
Correct: Not a size-up action. A traction splint is treatment of one limb. You have not reached the patient yet.
Correct: Do this in size-up. That report is the resource decision inside size-up.
Correct: Not a size-up action. A scene photo of patients is not care, and posting it violates privacy.
Scene size-up and safety
A caregiver's story does not match the bruises on a child, and the caregiver will not let you examine the child alone. The scene is otherwise calm. What is your priority besides the exam?
Choose the one best answer.
Wrong. The secondary exam and SAMPLE are real and useful. Obvious injuries are treated first, and the report is made through the proper channel, not by delaying care.
Correct. Care comes first. Document what you saw and what was said, and report as your state requires. Do not promise the caregiver secrecy.
Wrong. History matters. Asking who did it in front of the caregiver can wait until the child is safe and being treated.
Wrong. Documentation is required. A full exam before treating obvious injuries delays care, and accusing the caregiver is not the report.
Primary assessment
You are ventilating an infant. The head is flexed forward because the back of the head is large. What do you change?
Choose the one best answer.
Wrong. Suction is the right first airway step when there is fluid. This stem describes position, not gurgling. Flexion still has to be fixed.
Wrong. A collar can be part of later spinal care if trauma is present. This problem is head position during ventilation, and the first change is the pad under the shoulders.
Wrong. Oxygen and vital signs are appropriate around ventilation. They do not replace opening the airway of an infant who is being ventilated.
Correct. Shoulder padding lets the head rest in a sniffing position. Then reopen the airway and ventilate.
Primary assessment
A 4-year-old is sitting forward, drooling, and anxious, with a high fever. The parent says the child will not swallow. What do you avoid?
Choose the one best answer.
Wrong. The sitting position is protecting the airway. Do not force the child flat.
Correct. Do not use a tongue blade or otherwise instrument the mouth. Keep the child calm, give oxygen if tolerated, and transport.
Wrong. Transport is required. The action to avoid is instrumenting the throat.
Wrong. Oxygen the child will tolerate is appropriate. It is not the action you avoid.
Primary assessment
After a chest stabbing, one side of the chest has no breath sounds, the neck veins are distended, and the blood pressure is falling. What is your treatment?
Choose the one best answer.
Wrong. Sealing and oxygen are right. A detailed exam delays transport of a patient whose pressure is already falling.
Wrong. SAMPLE and a repeat pressure are useful on the way. Oxygen and transport come before a long history.
Wrong. That procedure is outside EMT scope. Do not perform it.
Wrong. Support of the chest wall can come with positioning. Walking a hypotensive patient is the wrong order.
Correct. Seal an open wound if one is present, support oxygenation and ventilation, and move. Tell the receiving team what you found.
Primary assessment
A segment of the chest wall moves in when the patient breathes in. Breathing is shallow. What does the patient need?
Choose the one best answer.
Correct. Shallow breathing with a flail chest is ventilatory failure. Assist ventilation and transport.
Wrong. Ventilation is indicated now. Waiting for cardiac arrest is the wrong order.
Wrong. Vital signs and SAMPLE are the secondary assessment. Inadequate breathing is decided in the primary assessment.
Wrong. Oxygen and splinting can follow. Shallow breathing needs ventilation, not a mask alone.
Primary assessment
An adult was pulled from a closed garage with a car running. The patient is confused, and the skin is pink. What do you do first for the exposure?
Choose the one best answer.
Wrong. The nonrebreather is right after they are out. Walking them, and treating them inside the garage, continues the exposure.
Wrong. SAMPLE and vital signs are appropriate after they are in fresh air. High-flow oxygen should not wait for the history.
Correct. Fresh air stops the exposure. High-flow oxygen is the treatment. A normal pulse oximeter can read high while carbon monoxide is still bound.
Wrong. Shutting the car off matters. Doing it before the patient is out of the garage keeps both of you in the atmosphere.
Primary assessment
Which patients need positive-pressure ventilation now? Select every patient that applies.
Select all that apply. This item is correct only if every selection is right.
Correct. The rate is too slow. Ventilate, and give naloxone if it is available.
Correct. After the airway is open, absent breathing is apnea. Ventilate.
Wrong. Speech and a normal saturation mean ventilation is adequate.
Wrong. Anxiety with normal speech is not ventilatory failure.
Secondary assessment
An adult front torso burn covers the chest and the abdomen only. Using the rule of nines, about what percentage is that?
Choose the one best answer.
Wrong. One percent is about the patient's palm, not the chest and abdomen.
Wrong. Nine percent is one arm, or the head, not the whole front of the trunk.
Correct. The anterior trunk is 18 percent. The posterior trunk is another 18 percent and is not described here.
Wrong. Thirty-six percent would be the entire trunk, front and back.
Secondary assessment
You are scoring an adult Glasgow Coma Scale. The patient opens their eyes to pain, speaks confused words, and withdraws from pain. Which total fits those findings?
Choose the one best answer.
Wrong. Three is the lowest total: no eye opening, no verbal response, and no motor response.
Wrong. Pain responses are scored inside each category. They are not a single score of 8.
Correct. Eye opening to pain is 2, confused verbal response is 4, and withdrawal to pain is 4.
Wrong. Fifteen is eyes open spontaneously, oriented speech, and obeying commands.
Patient treatment and transport
A partial-thickness burn is still hot. The patient is otherwise stable. What wound care is appropriate?
Choose the one best answer.
Correct. Water stops the burning. A dry cover protects the wound. Grease traps heat and contaminates the burn.
Wrong. A dry dressing is the right cover after cooling. Cooling stops the burning and should not wait for the hospital.
Wrong. Ice injures tissue further and can cause hypothermia.
Wrong. The secondary exam is appropriate after the burn is cooled and covered. Cooling is the first wound care, not the exam.
Wrong. Vital signs and SAMPLE come alongside care. They do not come before stopping the burning.
Patient treatment and transport
A hand was amputated in a saw. Bleeding is controlled. How do you transport the part?
Choose the one best answer.
Correct. Moist gauze, a bag, and cool packs outside the bag protect the part without freezing it.
Wrong. Transport of the patient is right, and the part should come too. It is wrapped and cooled, not packed against ice and not left behind.
Wrong. The dressing and vital signs are part of care. The part goes with the patient if it was found safely.
Wrong. Dressing the stump is right. Ice against the bare part freezes the tissue. Cool the bag from the outside.
Patient treatment and transport
Bowel is protruding from an abdominal laceration. What is the dressing?
Choose the one best answer.
Wrong. Vital signs are part of the exam. A dry dressing lets the bowel dry during the ride. Moisture comes now.
Wrong. SAMPLE can be gathered on the way. Replacing organs is a hospital step, not a field step.
Correct. Moisture keeps the bowel from drying. An occlusive layer holds that moisture. Do not push the bowel back in.
Wrong. Oxygen and transport are right. An uncovered evisceration dries and cools on the way.
Primary assessment
A newborn is just delivered. The baby is blue, limp, and not breathing. What do you do first?
Choose the one best answer.
Wrong. The cord is clamped when it is practical. An apneic baby is dried and ventilated first.
Wrong. APGAR is a real score and oxygen may follow. They do not come before opening the airway of a baby who is not breathing.
Wrong. Suction is for a baby who has obvious fluid obstructing the airway. Routine deep suction delays drying and ventilation.
Correct. Drying and warming are first. A baby who stays apneic gets positive-pressure ventilation.
Primary assessment
Arrange the first steps after a baby is born and is not breathing.
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. Dry and warm the baby. Heat loss is immediate. Drying is the first stimulation and the first protection.
Step 2, correct. Position and open the airway. The airway is opened after the baby is dried, and before you decide ventilation has failed.
Step 3, correct. Ventilate with a bag-mask device if the baby remains apneic. Once the baby is dry, warm, and positioned, apnea is treated with ventilation.
Step 4, correct. Reassess heart rate and breathing. After ventilation starts, heart rate tells you whether the ventilation is working.
Patient treatment and transport
A wheezing patient has a prescribed albuterol inhaler and can follow commands. A second patient has stridor, drooling, and a fever. Who gets help with the inhaler?
Choose the one best answer.
Wrong. Assisting a prescribed inhaler is in scope for the wheezing patient. Waiting is wrong for that patient and still wrong for the drooling child.
Wrong. Looking in that throat can close the airway. Oxygen the child will accept, and transport, come instead of an exam with a tongue blade.
Wrong. Vital signs and SAMPLE are appropriate. Albuterol is for the wheezing patient who can inhale it, not for stridor from a swollen upper airway.
Correct. Assist the prescribed inhaler for wheezing when the patient can use it. The drooling febrile patient needs calm oxygen and transport, not a forced inhaler.
Operations
The family shows you a valid do-not-resuscitate order for a patient in cardiac arrest. What do you do?
Choose the one best answer.
Correct. Confirm it is the right patient and a valid form, then do not resuscitate. Comfort measures the order permits are still care.
Wrong. Comfort measures are right when the order allows them. They are not a reason to add CPR, and oxygen for comfort is not resuscitation.
Wrong. The family history is useful. Their request does not cancel a valid order.
Wrong. The hospital will continue care. A valid order already in your hand means CPR does not start.
Operations
After a difficult call, which record of the call is acceptable?
Choose the one best answer.
Wrong. The report is the right place. Partners who are not on the call are not the treating team.
Correct. The report is the record. It goes to the people treating the patient and to the system that requires it.
Wrong. The verbal report is right at handoff. The written report is still required.
Wrong. Writing the report is required. Leaving the name off and delaying it does not meet the handoff.
Operations
Sort each action.
Place every finding. This item is correct only if every finding is in the right column.
Name yourself command and request a second ambulance
Correct column: Operations or size-up. Command and resources are operations, done in size-up.
Ventilate an apneic patient
Correct column: Patient treatment after the scene is safe. Ventilation is treatment. It starts once you can safely reach the patient.
Keep bystanders out of a fuel spill
Correct column: Operations or size-up. Isolating a hazard is scene safety, which is operations.
Cover an evisceration with a moist sterile dressing
Correct column: Patient treatment after the scene is safe. The dressing is treatment of the wound, after you are with the patient.
Original study items. Not an official examination, not affiliated with the National Registry of Emergency Medical Technicians, and not medical advice.