A 54-year-old is unresponsive on a couch. Bystanders report no trauma. You hear snoring. What is the first airway action?
Choose the one best answer.
Wrong. SAMPLE is useful and comes later. Snoring is an airway problem now.
Wrong. Oxygen is appropriate after the airway is open. It does not move the tongue.
Correct. With no trauma, a head-tilt chin-lift lifts the tongue off the posterior pharynx. That is the first airway move.
Wrong. An oropharyngeal airway is a reasonable adjunct after the airway is opened manually, and only if there is no gag. It is not the first move.
Primary assessment
An unresponsive driver is snoring after a high-speed crash. The windshield is starred in front of the driver. How do you open the airway?
Choose the one best answer.
Wrong. Oxygen is the right support after the airway is open. It does not stop the snoring.
Wrong. Looking at the back is a later exam. Open the airway before you roll for a secondary look.
Wrong. A collar is part of spinal motion restriction and comes after the airway is open. The snoring is the immediate problem.
Correct. The jaw thrust opens the airway and keeps the neck in line. Use it when spine injury is suspected.
Primary assessment
An unresponsive patient has blood and vomit in the mouth and you hear gurgling. What do you do before you ventilate?
Choose the one best answer.
Correct. Suction first. Limit an adult suction attempt to about 15 seconds so you do not cause hypoxia, then ventilate.
Wrong. Vital signs belong in the secondary assessment. Gurgling is a primary-assessment problem.
Wrong. Ventilation is the right next step after the airway is clear. Doing it first pushes blood and vomit into the lungs.
Wrong. Oxygen helps after the patient can actually move air. It does not remove the liquid.
Primary assessment
A patient was stabbed in the thigh. Bright red blood is pulsing from the wound and direct pressure has not stopped it. What do you do next?
Choose the one best answer.
Wrong. A detailed exam waits. Pulsing blood is a life threat now.
Wrong. A splint does not stop arterial bleeding.
Correct. Place it above the wound, tighten until the bleeding stops, and note the time. Do not remove it in the field.
Wrong. SAMPLE is secondary-assessment history. It does not come before bleeding control.
Primary assessment
An adult is unresponsive, is not breathing, and you do not definitely feel a pulse within 10 seconds. What do you do?
Choose the one best answer.
Correct. Start CPR. Adult compressions are 100 to 120 per minute and about 2 inches deep. Use an AED as soon as it arrives.
Wrong. The AED is used as soon as it is available, but you do not stand and wait to start compressions.
Wrong. Two breaths can follow the first cycle of compressions. Compressions come first when there is no pulse.
Wrong. Blood pressure and SAMPLE are later. There is no definite pulse, so compressions start now.
Primary assessment
An adult has a definite pulse. Breathing is 6 times a minute and shallow. How do you ventilate?
Choose the one best answer.
Wrong. A nonrebreather is reasonable when the patient is breathing adequately but hypoxic. Six shallow breaths a minute need ventilation, not just oxygen.
Correct. That is about 10 breaths a minute. Each breath should make the chest rise. Recheck the pulse so you notice if it disappears.
Wrong. Compressions are for no pulse. This patient has a definite pulse, so ventilation is the treatment.
Wrong. Glucose and SAMPLE matter and come after breathing is supported.
Primary assessment
Which findings mean breathing is inadequate? Select every finding that applies.
Select all that apply. This item is correct only if every selection is right.
Correct. Tidal volume is too small. The patient is not moving enough air.
Correct. Eight breaths a minute is too slow for an adult to ventilate adequately.
Wrong. Pink, warm, dry skin is a perfusion finding, not a sign of inadequate breathing.
Wrong. Full sentences mean the patient is moving enough air to talk. That is adequate breathing.
Correct. Neck and other accessory muscles mean the work of breathing has failed the usual muscles.
Primary assessment
Place each finding in the assessment where it belongs.
Place every finding. This item is correct only if every finding is in the right column.
Spurting blood from the wrist
Correct column: Deal with it in the primary assessment. Arterial bleeding is a life threat. Control it in the primary assessment.
A SAMPLE history
Correct column: Leave it for the secondary assessment. SAMPLE is history. Take it once life threats are being managed.
No chest rise
Correct column: Deal with it in the primary assessment. Absent breathing is a primary-assessment emergency. Open the airway and ventilate.
An OPQRST pain history
Correct column: Leave it for the secondary assessment. OPQRST describes a symptom. It is not how you find a life threat.
Primary assessment
An unresponsive patient is breathing normally and has a pulse. There is no trauma. How do you position them while you prepare to move?
Choose the one best answer.
Wrong. Vital signs belong with the secondary assessment. The airway position does not wait for a blood pressure.
Wrong. Oxygen and SAMPLE are reasonable after the airway is protected. A breathing unresponsive patient is positioned on the side first.
Correct. The recovery position lets fluid drain and helps keep the tongue forward. Confirm breathing first, then keep checking it.
Wrong. A back exam is part of the secondary assessment when trauma is possible. This patient has no trauma, and the recovery position comes before that exam.
Primary assessment
You are about to place an oropharyngeal airway in an unresponsive adult. The patient gags as the airway reaches the tongue. What do you do?
Choose the one best answer.
Correct. A gag means the oropharyngeal airway comes out. Manual opening is the move. A nasal airway is a later option only when there is no sign of basilar skull injury.
Wrong. A larger oropharyngeal airway reaches further back and gags the patient more. Once a gag reflex is present, no oral airway is used.
Wrong. Ventilation may be next if breathing is inadequate, after a tolerated airway is in place. Taping a gagged airway in place causes vomiting.
Wrong. Ventilation may be the next step if breathing is poor. Advancing an airway the patient is gagging on causes vomiting first.
Primary assessment
The AED analyzes and advises a shock. You deliver the shock. What is the next action?
Choose the one best answer.
Wrong. A second shock may be indicated later, after two minutes of CPR, if the rhythm is still shockable. Compressions come first.
Wrong. A pulse check comes at the next rhythm analysis, about two minutes later. Stopping now for vital signs leaves the patient without circulation.
Wrong. A pulse check is the right step at the next AED analysis, about two minutes from now. Stopping immediately after the shock leaves no circulation.
Correct. Start CPR again at once. The AED will prompt the next rhythm check after about 2 minutes.
Primary assessment
A conscious adult is choking and cannot speak or cough. What do you do?
Choose the one best answer.
Wrong. Coaching a cough is right when the patient can still cough and speak. This patient cannot. Oxygen does not move the object.
Wrong. Abdominal thrusts are part of the sequence. They come after back blows, not before.
Correct. Back blows are the first move for a severe obstruction in a conscious adult. Abdominal thrusts follow. If the patient becomes unresponsive, start CPR and look in the mouth before each breath.
Wrong. That is the correct care after they lose consciousness. They are conscious now, so back blows come first.
Primary assessment
During adult CPR, which performance is correct?
Choose the one best answer.
Wrong. 140 is too fast, and leaning prevents recoil, so the heart does not refill.
Wrong. Without compressions there is no circulation. Arrest care is compressions first.
Correct. Rate, depth, and full recoil are the three parts of a useful compression. Avoid depths greater than about 2.4 inches.
Wrong. That rate and depth are too low to circulate blood.
Primary assessment
An adult is breathing slowly after taking pills. You are not sure you feel a pulse. How long do you check before you decide?
Choose the one best answer.
Wrong. Ventilation is right when there is a pulse and breathing is bad. You decide about the pulse within 10 seconds before you choose ventilation or compressions.
Wrong. Oxygen and a two-minute recheck fit a patient you have already found has a pulse. You have not found that yet.
Wrong. The history is useful and comes after circulation is being supported.
Correct. If the pulse is not definite within 10 seconds, treat it as absent and start compressions.
Primary assessment
A patient has a pulse and slow breathing after a suspected opioid overdose. Which actions apply? Select every action that applies.
Select all that apply. This item is correct only if every selection is right.
Correct. Slow breathing with a pulse is respiratory failure. Ventilate.
Correct. For suspected opioid overdose with a pulse and abnormal breathing, naloxone is reasonable in addition to ventilation.
Wrong. Compressions are for no pulse. A definite pulse means you ventilate instead.
Wrong. The bottle and the history are useful, but they wait until breathing is being supported. Ventilation comes first.
Primary assessment
A patient is seizing on the floor. What do you do?
Choose the one best answer.
Wrong. A glucose check is appropriate after the seizure, especially if the patient stays confused. It is not done by wrestling a seizing patient.
Wrong. Oxygen may help after the seizure if breathing is poor. Restraint during the seizure causes injury and does not stop it.
Correct. Clear the area and protect the head. After the seizure, open the airway and check breathing. Suction if needed.
Wrong. Airway and breathing care is the right next step when the seizure stops. During the seizure you protect them from injury.
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.
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.
Primary assessment
You find an adult lying on a sidewalk with the eyes closed. The patient does not respond when you speak loudly, but groans and pulls the arm away when you pinch the muscle at the top of the shoulder. How do you record the mental status on the AVPU scale?
Choose the one best answer.
Correct. The patient groaned and withdrew only after a painful stimulus. That is P.
Wrong. Unresponsive means no response even to pain. Withdrawal from the pinch is a response.
Wrong. An alert patient has the eyes open and interacts with you without being prompted. This patient did neither.
Wrong. A loud voice got no response at all, so the patient does not reach the V level.
Primary assessment
Your partner is doing chest compressions on an adult in cardiac arrest when you arrive with the AED. Arrange the steps for using it.
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 AED on. Turning the AED on starts the voice prompts that guide the rest of the sequence.
Step 2, correct. Attach the pads to the bare chest. Pads go on the bare, dry chest after the device is on. Compressions continue while they are placed.
Step 3, correct. Tell everyone to stand clear while the AED analyzes the rhythm. Movement and touching can interfere with the rhythm analysis, so everyone stands clear.
Step 4, correct. Make sure no one is touching the patient, then press the shock button when advised. The shock is delivered only after you confirm no one is in contact with the patient.
Step 5, correct. Resume chest compressions right away. After the shock you go straight back to compressions. A pulse check comes after about 2 minutes of CPR.
Primary assessment
A 3-year-old pulled from a backyard pool has a strong pulse of 110 but is breathing only a few gasps a minute. You open the airway and begin bag-mask ventilation. At what rate do you ventilate?
Choose the one best answer.
Wrong. Every 6 seconds is the adult rescue-breathing rate. A child needs faster ventilation.
Correct. This matches current AHA pediatric guidance of 20 to 30 breaths a minute for a child with a pulse.
Wrong. Every 3 to 5 seconds was the older pediatric rate. The guideline has since been raised.
Wrong. A breath every second is hyperventilation. It raises chest pressure and fills the stomach with air.
Primary assessment
An adult with a deformed, swollen thigh after a motorcycle crash may be bleeding internally. Which findings are early signs that the body is compensating for blood loss? Select every finding that applies.
Select all that apply. This item is correct only if every selection is right.
Wrong. Hypotension appears when compensation is failing. It is a late sign, not an early one.
Correct. A rising heart rate is one of the first ways the body keeps up output after blood loss.
Correct. Reduced blood flow to the brain often shows first as restlessness or anxiety.
Correct. Vessels in the skin constrict to send blood to the core, so the skin turns pale, cool and sweaty.
Wrong. Warm, flushed skin points away from blood loss. Bleeding patients clamp down the vessels in the skin.
Primary assessment
A man was stabbed in the right side of the chest. Each time he breathes you hear air moving through the wound, and blood bubbles at the site. You have covered it with your gloved hand. What is the most appropriate care for the wound?
Choose the one best answer.
Correct. An airtight dressing stops air entering through the wound. Watching breathing catches a tension pneumothorax building under the seal.
Wrong. An open wound lets more air in with each breath and the lung can collapse. Cover it right away.
Wrong. Packing gauze into a chest wound does not seal it and can push material into the chest. Chest wounds are sealed, not packed.
Wrong. Gauze lets air pass through, so a dry pad does not seal the wound however much you add.
Primary assessment
You form a general impression of a sick 10-month-old from the doorway using the pediatric assessment triangle. Sort each finding into the part of the triangle it belongs to.
Place every finding. This item is correct only if every finding is in the right column.
Does not look at or follow the parent's face
Correct column: Appearance. How the child looks at people and things is part of appearance. A child who does not track the parent's face may have poor brain perfusion or oxygenation.
Head bobs with each breath
Correct column: Work of breathing. Head bobbing shows the child is using neck muscles to breathe, a sign of increased work of breathing.
Mottled skin on the arms and legs
Correct column: Circulation to the skin. Mottling shows poor blood flow to the skin, part of circulation.
Weak cry, and cannot be comforted by the parent
Correct column: Appearance. The strength of the cry and whether the child can be soothed are both part of appearance. A weak cry and a child who cannot be comforted are worrying signs.
Grunting at the end of each breath
Correct column: Work of breathing. Grunting is an abnormal airway sound that shows increased work of breathing.
Pale lips and skin
Correct column: Circulation to the skin. Pallor is a sign of poor circulation to the skin.
Primary assessment
After the primary assessment, which patients should be treated as high priority for rapid transport? Select every patient that applies.
Select all that apply. This item is correct only if every selection is right.
Correct. Responding but not following commands is an altered mental status, a sign of a problem with the brain, its oxygen, or its blood flow.
Wrong. Back strain with normal vital signs and normal strength has no sign of a life threat. Assess further, but it is not high priority.
Correct. Chest pain with a systolic pressure under 100 suggests poor perfusion from a heart problem. This patient needs rapid transport.
Wrong. An isolated limb injury with mild pain and good circulation is not a threat to life. Splint it and reassess on the way.
Correct. Bleeding that will not stop with direct pressure is uncontrolled bleeding, and the patient keeps losing blood until a hospital can stop it.
Primary assessment
A patient has severe bleeding from a deep wound on the thigh. You placed a tourniquet 2 to 3 inches above the wound and tightened the windlass until it will not turn any further, but bright red blood is still flowing from the wound. What do you do next?
Choose the one best answer.
Correct. Leave the first tourniquet in place and add a second just above it, closer to the torso. Together they compress a wider stretch of the limb.
Wrong. Elevation does not stop arterial bleeding, and waiting lets the patient keep losing blood.
Wrong. Pressure points are not a reliable way to stop limb bleeding, and taking the tourniquet off throws away the control you have.
Wrong. Loosening it lets the bleeding restart in full, and a tourniquet placed over the wound itself cannot squeeze the vessel above the injury.
Primary assessment
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.
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.
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.
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.
Primary assessment
A 61-year-old man collapsed in a store. He does not respond when you tap him and shout. About every 8 seconds he takes a slow, noisy gasp. You do not feel a carotid pulse within 10 seconds. A bystander tells you he is still breathing. Your partner has the AED. What do you do?
Choose the one best answer.
Wrong. The recovery position is for an unresponsive patient who has a pulse and breathes normally. Gasps do not count as normal breathing.
Wrong. Adult CPR starts with compressions. Delaying them to place an airway costs blood flow to the brain and heart.
Correct. Gasping is not normal breathing, and there is no pulse. This is cardiac arrest, so compressions start now and the AED goes on as soon as it is ready.
Wrong. Rescue breathing alone is for a patient who has a definite pulse. Without a pulse, breaths do not move blood.
Primary assessment
A 40-year-old woman at a restaurant grabbed her throat while eating steak. She is coughing forcefully, and between coughs she tells you, "It's stuck." Her skin color is normal. What do you do?
Choose the one best answer.
Correct. She can talk and cough hard, so air is moving. A forceful cough clears the object better than anything you can do, and you step in only if it fails.
Wrong. A blind finger sweep can push the food deeper and is not done. You remove an object only if you can see it, and her forceful cough is already doing that job.
Wrong. Back blows are also for a severe obstruction, given in rounds of 5 with 5 abdominal thrusts once the cough fails. While she coughs effectively, they add nothing.
Wrong. Thrusts are for a severe obstruction, when the patient cannot speak, cough or breathe. While her own cough is moving air, they are not needed and can injure her.
Primary assessment
An adult has just stopped having a seizure. He is unresponsive and snoring, his jaw is clenched, and he gags when you try to open his mouth. He has no head or facial injury. A head-tilt, chin-lift helps but does not stop the snoring. Which airway adjunct do you use?
Choose the one best answer.
Correct. The nasal airway passes above the tongue without triggering the gag reflex, and a water-soluble lubricant eases it through the nostril.
Wrong. A tongue blade changes how the oral airway goes in, not whether he tolerates it. He still gags.
Wrong. Any oral airway, however it is inserted, can make a patient with a gag reflex vomit, and his clenched jaw will not let it in.
Wrong. Suction clears fluid but does nothing for a tongue that is blocking the airway. The snoring tells you the tongue is the problem.
Primary assessment
You are ventilating an adult who has a slow pulse and is not breathing, using a bag-valve mask with oxygen. Which findings show your ventilations are adequate? Select every finding that applies.
Select all that apply. This item is correct only if every selection is right.
Wrong. Rising resistance suggests the airway is closing, the stomach is filling, or something is blocking air. Reassess the airway.
Correct. Visible chest rise with each breath is the first sign that air is reaching the lungs.
Correct. Rising saturation shows the breaths are delivering oxygen to the blood.
Correct. Hypoxia slows the heart. A rate climbing back toward normal shows oxygen is reaching the tissues.
Wrong. A growing abdomen means air is going into the stomach. Reposition the airway and give each breath gently over about 1 second.
Primary assessment
While you ventilate an unresponsive adult with a bag-valve mask, you notice the upper abdomen is becoming swollen and firm. The chest is still rising with each breath. What do you change?
Choose the one best answer.
Wrong. Pressing on a full stomach can force its contents into the throat, where they can be breathed into the lungs.
Wrong. Faster breaths make things worse. They leave less time for air to leave the lungs and send more air into the stomach.
Wrong. The patient still needs the breaths. Stopping trades a stomach problem for hypoxia.
Correct. A well-opened airway and slow, gentle breaths send air into the lungs instead of the stomach.
Primary assessment
A man was stabbed in the crease of the groin. Bright red blood is spurting from the wound, which is too close to the torso for a tourniquet. Firm pressure with your gloved hand has not stopped the bleeding. You carry hemostatic gauze. What do you do next?
Choose the one best answer.
Wrong. Gauze laid on the surface does not reach the bleeding vessel deep in the wound, and a wrap around the thigh cannot press hard enough at the groin.
Wrong. A tourniquet below the wound sits downstream of the bleeding. It cannot stop blood coming from above it.
Wrong. Elevation and distant pressure points do not stop arterial bleeding. Pressure has to be right on the bleeding vessel.
Correct. Packing puts the gauze against the bleeding vessel. Firm pressure on top for several minutes gives the clot a chance to form.
Primary assessment
You were giving abdominal thrusts to a man choking on food when he went limp. You lower him to the floor. He is unresponsive. 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. Begin chest compressions. Compressions start CPR right away and can force the object up and out.
Step 2, correct. Open the airway and look in the mouth for the object. Each time you open the airway for breaths, you look in the mouth first.
Step 3, correct. Remove the object with your fingers if you can see it. An object you can see can be lifted out before you try to ventilate.
Step 4, correct. Attempt a breath and watch for the chest to rise. A breath comes after you have looked in the mouth. If the chest does not rise, go back to compressions.
Primary assessment
A motorcyclist was thrown over the handlebars and is unresponsive with a pulse. Your partner holds his head in line. An oral airway is in place, the mouth is clear, and you have a good mask seal, but with a jaw-thrust maneuver you still cannot make the chest rise with the bag-valve mask. What do you do next?
Choose the one best answer.
Wrong. More force through a closed airway does not reach the lungs. It pushes air into the stomach and raises the risk of vomiting.
Correct. When a jaw thrust fails, a head-tilt chin-lift is the next way to open the airway. Tilt only as far as it takes to make the chest rise.
Wrong. The mouth is already clear, so drainage is not the problem, and rolling him gives up the inline hold without opening the airway.
Wrong. A patient who cannot be ventilated will die of hypoxia whatever the spine shows. The airway takes priority over spinal protection.
Primary assessment
A factory worker caught his forearm in a machine. The machine is locked out and the scene is safe. He is awake and shouting for help, and bright red blood is spurting from a deep cut on his forearm and pooling on the floor. What do you do first?
Choose the one best answer.
Correct. Spurting, pooling blood is a life threat that is treated as soon as you see it, ahead of other assessment steps.
Wrong. Pulse and skin findings come after the bleeding is controlled. Checking them while blood spurts wastes time.
Wrong. Oxygen does not help if he keeps losing the blood that carries it. Stop the bleeding first.
Wrong. Breathing is checked in the primary assessment, but a patient who is shouting is moving air. Uncontrolled bleeding is the faster threat.
Primary assessment
A patient has severe bleeding from a deep wound on the lower thigh, and you are applying a windlass tourniquet. Arrange the steps. 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. Expose the wound and place the band 2 to 3 inches above it, not over a joint. The tourniquet must sit above the wound and clear of a joint, so you expose the wound and place it first.
Step 2, correct. Pull the strap tight around the leg and fasten it before you turn the windlass. Taking the slack out of the strap first lets the windlass stop the bleeding with fewer turns.
Step 3, correct. Turn the windlass until the bleeding stops. The windlass is turned only after the strap is snug, and you keep turning until the bleeding stops.
Step 4, correct. Lock the windlass in place so it cannot unwind. Locking the windlass keeps it from unwinding during the move, so it follows tightening.
Step 5, correct. Write down the time the tourniquet went on and tell the receiving staff. Recording the time comes last, so the hospital knows how long the limb has been without blood flow.
Primary assessment
You are called to a 58-year-old woman who feels weak and dizzy. The scene is safe and you have put on gloves. Arrange the steps of your primary assessment in order. One step does not belong in the primary assessment.
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. Form a general impression as you walk up to her. The general impression is formed as you approach, before you touch the patient.
Step 2, correct. Check her level of responsiveness using AVPU. Responsiveness is checked right after the general impression, and it tells you how well she can protect her own airway.
Step 3, correct. Make sure her airway is open. The airway comes first among the ABCs, because nothing else works without an open airway.
Step 4, correct. Assess the rate and quality of her breathing. Breathing is checked once the airway is open: is the rate and depth adequate?
Step 5, correct. Check her pulse, skin, and for any major bleeding. Circulation comes after breathing: pulse, skin color, temperature and condition, and any major bleeding.
Step 6, correct. Decide on her priority for transport. The transport priority decision closes the primary assessment, once you know whether any life threats are present.
Primary assessment
You are ventilating an unresponsive adult with a bag-valve mask by yourself. He has a thick beard, and with every squeeze you hear air hissing out around the mask while his chest barely rises. Your partner has just finished setting up the oxygen. What is the best next step?
Choose the one best answer.
Wrong. More oxygen flow does not stop air leaking around the mask. The chest still will not rise until the seal is fixed.
Wrong. A nonrebreather mask gives oxygen only to a patient who is breathing adequately. It does not ventilate a patient who needs your breaths.
Correct. Two hands on the mask give a much better seal and jaw lift than one. The leak is the problem, and a second rescuer on the bag fixes it.
Wrong. Air still escapes through the same gap. Faster, harder squeezes also push air into the stomach and leave too little time to breathe out.
Primary assessment
A family of four is brought out of a house where a gas furnace has been malfunctioning. The father has a severe headache, is nauseated, and is slow to answer questions. His pulse oximeter reads 99% on room air. How should you treat him?
Choose the one best answer.
Correct. His headache, nausea and slowed thinking after exposure point to carbon monoxide poisoning, and high-flow oxygen is the treatment no matter what the oximeter shows.
Wrong. Low-flow oxygen is not enough. High-flow oxygen speeds the removal of carbon monoxide from the blood, and the reading will not warn you if he gets worse.
Wrong. The oximeter counts hemoglobin carrying carbon monoxide as if it carried oxygen. A 99% reading here can hide serious poisoning.
Wrong. Every finger gives the same falsely normal number in carbon monoxide poisoning, and rechecking only delays his oxygen.
Primary assessment
You find a 71-year-old man in cardiac arrest, and your partner starts compressions while you open the AED. When you bare his chest, you see a firm lump about the size of a matchbox under the skin just below his right collarbone, right where the upper pad would go. What do you do?
Choose the one best answer.
Wrong. The device can block or divert part of the shock, so the pad does not go directly over it.
Correct. Moving the pad off the device, or switching to front-and-back placement, lets the shock reach the heart without delay.
Wrong. An implanted defibrillator may not shock at all, and waiting for it delays his care. Attach the AED and follow its prompts.
Wrong. An implanted device is not a reason to withhold defibrillation. A patient in cardiac arrest needs the AED as soon as possible.
Primary assessment
An 8-month-old was found limp in her crib. She is unresponsive and was breathing only a few gasps a minute. You have been giving bag-mask ventilations with oxygen, and the chest rises with each breath. The brachial pulse is now 50 per minute, and her skin is pale and mottled. Your partner has the AED. What do you do next?
Choose the one best answer.
Wrong. The AED is used once CPR is under way, not instead of compressions. A slow heart that still has a pulse is not a shockable rhythm, so waiting for analysis delays the care she needs.
Correct. A pulse under 60 with pale, mottled skin despite good ventilation calls for CPR in an infant. Compressions move blood while you keep ventilating.
Wrong. Breathing faster than the recommended rate does not raise a failing heart rate and can cause gastric distension. The slow pulse needs compressions.
Wrong. Rescue breathing alone fits a child with an adequate pulse. A rate under 60 with poor perfusion means the heart is not moving enough blood, so breaths alone are not enough.
Primary assessment
A 67-year-old man with COPD has been struggling to breathe for two days. When you arrived he was sitting upright, breathing 34 times a minute and answering in short phrases. You placed him on oxygen. Ten minutes later his respiratory rate is 10, his breaths are shallow, his head keeps dropping forward, and he opens his eyes only when you speak loudly. What do you do now?
Choose the one best answer.
Correct. Shallow, slow breathing with a falling level of responsiveness is inadequate breathing. Assisted ventilation with oxygen moves enough air to correct it.
Wrong. Lying flat makes breathing harder for a patient in respiratory distress, and his problem is ventilation, not blood flow.
Wrong. The lower number is not a sign of recovery. Combined with shallow breaths and drowsiness, it shows he is exhausted and no longer moving enough air.
Wrong. A patient with inadequate breathing needs more ventilation and oxygen, not less. Withholding oxygen from a hypoxic patient is never the fix.
Original study items. Not an official examination, not affiliated with the National Registry of Emergency Medical Technicians, and not medical advice.