You and your partner are doing CPR on a 6-month-old in cardiac arrest. Your partner is giving the breaths with a bag-valve mask. Which compression technique and ratio are correct?
Choose the one best answer.
Correct. Encircling the chest with both hands and pressing with both thumbs gives deeper, steadier compressions, and two rescuers use 15:2 for infants and children.
Wrong. The heel of one hand is an accepted infant technique when you cannot encircle the chest, but 5:1 is not a current ratio. Two rescuers use 15:2.
Wrong. Since the 2025 AHA update, the two-finger technique is no longer recommended because it compresses too shallowly, and 30:2 is the lone-rescuer ratio.
Wrong. The technique fits two rescuers, but 30:2 is for a lone rescuer. Two rescuers give more breaths at 15:2.
Secondary assessment
In a moving ambulance you cannot hear the blood pressure. You inflate the cuff, slowly let the air out while feeling the radial pulse, and feel the pulse return at 96 mm Hg. How do you record the blood pressure?
Choose the one best answer.
Wrong. You did obtain a useful systolic value. Throwing it away leaves the hospital without a trend.
Wrong. A zero suggests a measured diastolic of zero, which is not what happened. The diastolic was simply not measured.
Correct. The returning pulse marks the systolic pressure, and the P tells the next provider how it was taken.
Wrong. A diastolic number cannot be felt. Writing an estimate records a value you never measured.
Scene size-up and safety
You are called to a house where a man put his arm through a glass window. From the doorway you can see bright red blood spurting from a cut on his forearm. Which protection do you put on before you touch him?
Choose the one best answer.
Correct. Gloves cover the hands, and eye protection with a mask covers the mucous membranes a spray of blood can reach.
Wrong. Spurting blood can spray well beyond the arm. Gloves protect the hands but leave the eyes and mouth exposed.
Wrong. A gown protects clothing from large amounts of blood, but the face is the part a spurting bleed is most likely to splash.
Wrong. An N95 protects against airborne germs, which is not the risk here, and it leaves the eyes uncovered.
Operations
You are driving with lights and siren to a cardiac arrest and come to a red light at a busy intersection. What do you do?
Choose the one best answer.
Wrong. Lights and siren generally allow you to proceed through a red light with caution. Waiting for green adds delay to a call where every minute counts.
Correct. Stopping, then confirming each lane has yielded before you go, protects your crew and the public and still gets you there.
Wrong. Turning off the siren takes away the warning other drivers need right when they need it most.
Wrong. Other drivers may not hear or see you. You still owe them due regard, and assuming they will yield is how intersection crashes happen.
Primary assessment
An unresponsive adult has no gag reflex, and you decide to place an oral airway. How do you choose the right size?
Choose the one best answer.
Wrong. Nose tip to earlobe is how you measure a nasal airway, not an oral one.
Correct. This distance matches the curve from the lips to the back of the tongue, so the flange rests at the lips and the tip sits behind the tongue.
Wrong. The little finger is an old rule of thumb for the diameter of a nasal airway. It says nothing about an oral airway's length.
Wrong. Lips to chin is far too short. The airway would end in the mouth and could push the tongue back.
Primary assessment
An unresponsive adult with no facial injury is snoring and gags when you try an oral airway. You have chosen a nasal airway of the right size for the right nostril. How do you insert it?
Choose the one best answer.
Correct. The nasal passage runs straight back along its floor, and the bevel toward the septum lets the tip slide past the turbinates with the least damage.
Wrong. Forcing past resistance can tear the lining of the nose and cause heavy bleeding into the airway. Withdraw and try the other nostril.
Wrong. Petroleum-based lubricants are not used. They can damage tissue and cause harm if they reach the lungs.
Wrong. The nasal passage runs straight back, not up. Aiming toward the eye drives the tip into the turbinates and causes bleeding.
Scene size-up and safety
You arrive at a single-car crash on a rural road at night. The scene is safe. The driver is unresponsive behind the wheel. In the back seat you see an empty child safety seat with a diaper bag beside it, and the rear door is open. What is the best action?
Choose the one best answer.
Wrong. A note for the hospital comes far too late to help a child left at the scene.
Wrong. Nothing on scene proves the seat was empty. A missed child could be badly hurt in the dark nearby.
Wrong. A phone call takes time and may reach no one. A child thrown from the car could be hurt nearby in the dark, so the search starts now.
Correct. Splitting the crew keeps the driver's care going while you look for a possible second patient and get the extra units a second patient needs.
Patient treatment and transport
During a delivery in the field, the baby's head has just delivered. As you support it, you feel the umbilical cord wrapped loosely around the baby's neck. What do you do?
Choose the one best answer.
Wrong. Pushing back on the head is not done for a cord around the neck. Holding the head off the cord is the care for a prolapsed cord, a different emergency.
Wrong. Clamping and cutting is kept for a cord too tight to slip off. Cutting a loose cord ends the baby's blood supply from the placenta before the body is delivered, for no gain.
Wrong. Pulling on the head can injure the baby and does not free the cord. The baby is supported, not pulled.
Correct. A loose cord slips easily over the head, which frees the neck so the delivery can continue.
Scene size-up and safety
Dispatch sends you to an adult with a cough that has lasted two months. On arrival a relative tells you the patient has night sweats, has been losing weight, and has coughed up blood. Before you go in, which protection do you put on?
Choose the one best answer.
Wrong. Eye protection guards against splashes, but nothing here protects your lungs from an airborne infection.
Correct. The history points to tuberculosis, an airborne disease. A fit-tested N95 filters the small particles, and a mask on the patient reduces how many reach the air.
Wrong. A gown and distance help with contact and large droplets. Airborne particles hang in the room, so a few feet of distance does not protect you.
Wrong. A surgical mask stops large droplets but does not seal well enough to filter the tiny airborne particles that carry tuberculosis.
Primary assessment
A 7-month-old was eating at the table and suddenly cannot cry, cough, or make any sound. The infant is still awake. Arrange the steps of care. One step does not belong.
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. Hold the infant face down along your forearm, head lower than the chest, supporting the jaw. Face down with the head lower than the chest lets gravity help, and supporting the jaw keeps the airway in line. This position comes first.
Step 2, correct. Give up to 5 firm back slaps between the shoulder blades with the heel of your hand. Back slaps are the first maneuver once the infant is positioned face down.
Step 3, correct. Turn the infant face up, supporting the head, and give up to 5 chest thrusts on the lower half of the breastbone. Chest thrusts come after the back slaps. They are given on the lower half of the breastbone, the same place you would compress during infant CPR.
Step 4, correct. Repeat the cycle until the object comes out or the infant becomes unresponsive. Keep alternating back slaps and chest thrusts. If the infant becomes unresponsive, start CPR and look in the mouth before each set of breaths.
Primary assessment
During the primary assessment you check each patient's circulation. Sort each patient by the pulse you check first.
Place every finding. This item is correct only if every finding is in the right column.
An alert adult with a cut hand who is talking to you
Correct column: Radial. A responsive patient is perfusing their brain, so the radial pulse is checked first. Its rate and strength tell you about perfusion.
An adult who collapsed and is not breathing normally
Correct column: Carotid. In an unresponsive adult the carotid pulse is the most reliable, because it can still be felt when the pressure is too low for a radial pulse.
A 4-month-old who is limp and not responding
Correct column: Brachial. An infant's neck is short and padded, so the brachial pulse on the inside of the upper arm is the one to feel.
A 7-year-old with a painful wrist who is crying and answering questions
Correct column: Radial. A responsive child is checked at the radial pulse, just like a responsive adult.
An unresponsive older adult with snoring respirations
Correct column: Carotid. An unresponsive adult is checked at the carotid pulse, whether or not they are breathing.
Primary assessment
In which patient is capillary refill the most useful sign of perfusion during the primary assessment?
Choose the one best answer.
Wrong. Older age and cold skin both slow capillary refill on their own, so a slow refill here does not reliably mean shock.
Correct. In a young child capillary refill tracks perfusion well, and a refill longer than 2 seconds in a dehydrated toddler is a warning sign.
Wrong. Smoking and vascular disease narrow the small vessels, so refill can be slow even when the patient is perfusing well.
Wrong. Cold makes the skin vessels clamp down, which slows refill regardless of how well the core is perfused.
Patient treatment and transport
A 62-year-old man has crushing chest pain and carries his own prescribed nitroglycerin. His blood pressure is 142/88. While you take his medication history, he says he took sildenafil (Viagra) last night. What do you do about the nitroglycerin?
Choose the one best answer.
Wrong. Lying flat does not prevent the severe drop this drug combination can cause. The sildenafil makes nitroglycerin unsafe in any position.
Wrong. A normal blood pressure now does not protect him. The drug combination can cause a sudden, severe drop after the dose.
Wrong. A smaller dose still carries the same interaction. EMTs do not split nitroglycerin doses to work around a contraindication.
Correct. Sildenafil within the past day is a contraindication to nitroglycerin. Report it so the hospital also knows to avoid nitrates.
Operations
You arrive as the fourth ambulance at a mass-casualty incident. Command and a staging area are already set up, and you can see injured people on the road ahead of you. What do you do?
Choose the one best answer.
Wrong. Walking up to the incident commander pulls them away from running the scene. Check in through staging instead.
Wrong. Transport decisions are made through the transport group so patients are spread across hospitals. Leaving with whoever you reach first defeats that.
Wrong. Starting work without an assignment is freelancing. Command does not know where you are, and patients may get triaged twice or not at all.
Correct. Staging lets command hold resources in one place and send them where they are needed most, so every unit is accounted for.
Primary assessment
An unresponsive adult with a pulse is breathing shallowly, and you hear gurgling from vomit in the mouth. You have a rigid suction catheter. Arrange the steps of suctioning. One step does not belong.
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. Turn the unit on and confirm it pulls suction at the tip. A unit that fails is found before the catheter is in the mouth, not while the patient is waiting for air.
Step 2, correct. Insert the tip into the mouth, no farther than you can see, without suction applied. Inserting without suction avoids pulling on the soft tissue, and keeping the tip in view keeps it out of the back of the throat.
Step 3, correct. Apply suction while you withdraw the tip, for no more than 15 seconds. Suction is applied on the way out, and the time limit keeps the patient from going too long without oxygen.
Step 4, correct. Ventilate with a bag-mask device and oxygen, then listen again for gurgling. This patient is breathing shallowly and was without air during suctioning, so ventilation follows. Gurgling that returns means suction again.
Primary assessment
A 5-year-old pulled from a pool is unresponsive, has a pulse, and has no gag reflex. You are ventilating and have chosen an oral airway of the right size. How do you insert it?
Choose the one best answer.
Correct. The tongue blade keeps the tongue from being pushed back, and inserting the airway right side up follows the natural curve without twisting against the palate.
Wrong. Without a tongue blade, the curve of the airway can push a child's tongue back into the throat and block the airway you are trying to open.
Wrong. The upside-down and rotate method is taught for adults. In a child it can injure the soft palate and cause bleeding into the airway.
Wrong. A child's airway is best opened with the head in a neutral or slightly extended position. Tilting far back can kink the airway closed.
Secondary assessment
A 30-year-old was thrown from a car that rolled over. He responds only to pain. You have managed his airway, breathing, and bleeding and decided on rapid transport. Which approach fits his secondary assessment?
Choose the one best answer.
Wrong. He responds only to pain and cannot give a reliable history. The physical exam has to find his injuries.
Wrong. Checking the limbs is part of the exam, but it skips the head, chest, abdomen, pelvis, and back, where the deadliest injuries hide.
Correct. Ejection from a rollover can injure any part of the body, and he cannot point to his injuries, so every region is examined.
Wrong. An obvious injury can distract from a hidden one, such as bleeding into the abdomen. With this mechanism, a focused exam misses too much.
Operations
Police have secured a home where a man was shot in the chest. He is breathing and has a pulse. While you treat him, how do you help preserve evidence?
Choose the one best answer.
Wrong. Cleaning up disturbs blood patterns and other evidence. Leave the scene as it is and tell the police what you changed.
Wrong. A gunshot wound to the chest needs to be exposed and treated now. Evidence never delays care of a live patient.
Correct. Cutting around the holes exposes the wound just as fast and leaves the evidence intact, and telling the police lets them account for what changed.
Wrong. Holes in clothing are evidence of the weapon and the distance it was fired from. Cutting through them destroys it.
Patient treatment and transport
A 70-year-old has sudden slurred speech and weakness in the left arm. Her blood pressure is 168/94 and her oxygen saturation is 97%. Which actions belong in her care? Select every action that applies.
Select all that apply. This item is correct only if every selection is right.
Correct. An early alert lets the stroke team and the scanner be ready when you arrive, which shortens the time to treatment.
Wrong. Symptoms that clear may still be a warning of a major stroke, and waiting uses up treatment time. Transport without delay.
Correct. Stroke often weakens swallowing, so food, drink, or pills can be inhaled into the lungs.
Wrong. A stroke can be caused by bleeding in the brain, and aspirin would make that worse. It is withheld until imaging at the hospital.
Correct. Many stroke treatments are only offered at certain hospitals, and protocols route these patients there.
Patient treatment and transport
An adult was the driver in a moderate-speed rear-end crash. Which findings, if present, mean spinal motion restriction is indicated? Select every finding that applies.
Select all that apply. This item is correct only if every selection is right.
Wrong. Pain in the shoulder muscles, away from the midline, is common after a crash and does not point to a spinal injury on its own.
Correct. Midline tenderness over the spine can mean a fracture of the vertebrae.
Wrong. Walking at the scene does not rule out a spinal injury, but it is not an indication by itself. The decision rests on the exam findings.
Correct. An intoxicated patient cannot be relied on to report pain or tenderness, so the exam cannot clear the spine.
Correct. New numbness or tingling is a neurological sign that the spinal cord or nerve roots may be involved.
Original study items. Not an official examination, not affiliated with the National Registry of Emergency Medical Technicians, and not medical advice.