AEMCA - Advanced Emergency Medical Care Assistant Medical Emergencies Questions and Answers — Questions and Answers
Question 1: A 58-year-old male with a history of type 1 diabetes is found confused and diaphoretic. His glucometer reads 2.1 mmol/L. He is able to follow simple commands but is too disoriented to swallow safely. An IV has been established. According to Ontario ALS PCS, what is the most appropriate initial treatment for this patient?
- Administer 1 mg of Glucagon intramuscularly.
- Administer 25 grams of Dextrose 50% (D50W) slow IV push.
- Administer 10 grams of Dextrose 10% (D10W) slow IV push, and reassess. (Correct answer)
- Encourage the patient to drink a glass of orange juice.
Correct answer: Administer 10 grams of Dextrose 10% (D10W) slow IV push, and reassess.
Current Ontario ALS PCS guidelines favor D10W over D50W for treating hypoglycemia due to a lower risk of extravasation injury and rebound hypoglycemia. D10W is administered in 10-gram aliquots, followed by a reassessment of the patient's blood glucose level and clinical status. Glucagon is an alternative if IV access cannot be obtained, and oral glucose is inappropriate as the patient cannot swallow safely.
Question 2: You are managing a 30-year-old patient who is experiencing a prolonged generalized tonic-clonic seizure lasting more than 5 minutes. Which of the following is the first-line medication and preferred route of administration for status epilepticus according to AEMCA protocols, especially when IV access is delayed?
- Lorazepam, IV
- Midazolam, IM (Correct answer)
- Diazepam, Rectal
- Phenytoin, IV infusion
Correct answer: Midazolam, IM
For status epilepticus in the prehospital setting, especially when IV access is not yet established or is difficult to obtain during a seizure, Midazolam administered intramuscularly (IM) is the preferred first-line benzodiazepine due to its rapid absorption and ease of administration.
Question 3: A 72-year-old female presents with a sudden onset of right-sided facial droop, slurred speech, and right arm weakness that began exactly 90 minutes ago. Her vital signs are stable. Which of the following is the most critical piece of information to relay to the receiving stroke center?
- The patient's score on the Cincinnati Prehospital Stroke Scale.
- The patient's most recent blood pressure reading.
- The exact time of symptom onset ('last known well'). (Correct answer)
- A detailed list of the patient's home medications.
Correct answer: The exact time of symptom onset ('last known well').
While all options are important pieces of information, the 'last known well' time is the most critical factor in determining the patient's eligibility for time-sensitive thrombolytic therapy (fibrinolysis) or endovascular treatment. The treatment window is strictly time-dependent, and this information is paramount for the stroke team's decision-making process.
Question 4: Which of the following constellations of findings is most indicative of a patient meeting prehospital sepsis criteria, warranting a 'sepsis alert' notification to the receiving hospital?
- Suspected infection, fever of 38.5°C, and a new onset of confusion. (Correct answer)
- Productive cough, heart rate of 95 bpm, and a blood pressure of 130/80 mmHg.
- History of a UTI, respiratory rate of 18, and warm, dry skin.
- Localized cellulitis, normal mental status, and a heart rate of 88 bpm.
Correct answer: Suspected infection, fever of 38.5°C, and a new onset of confusion.
Prehospital sepsis screening tools (like qSOFA or SIRS) look for a suspected source of infection plus signs of systemic response or organ dysfunction. The combination of a suspected infection, fever (temperature >38°C), and altered mental status (new confusion) strongly suggests sepsis with organ dysfunction, meeting the criteria for a sepsis alert.
Question 5: You are called to a 24-year-old found unresponsive in a public washroom. The patient has a respiratory rate of 4 breaths per minute, pinpoint pupils, and central cyanosis. What is the most important initial intervention after ensuring the airway is open?
- Establish IV access for fluid resuscitation.
- Administer Naloxone via the intranasal or intramuscular route. (Correct answer)
- Perform a 12-lead ECG to rule out a cardiac cause.
- Apply high-flow oxygen via a non-rebreather mask.
Correct answer: Administer Naloxone via the intranasal or intramuscular route.
The clinical presentation is classic for an opioid overdose causing severe respiratory depression. The most critical and definitive initial intervention is to reverse the effects of the opioids by administering Naloxone. While airway and ventilation support are crucial and should be done concurrently, Naloxone is the specific antidote that addresses the root cause of respiratory failure.
Question 6: You are treating a patient found unconscious at an outdoor event on a very hot day. The patient has hot, dry skin, a core temperature of 41°C, and altered mental status. Which of the following actions is the most critical and immediate prehospital treatment for classic heat stroke?
- Administering a 500 mL IV fluid bolus of normal saline.
- Administering antipyretics like Acetaminophen.
- Initiating rapid active cooling measures. (Correct answer)
- Placing the patient in the recovery position to protect the airway.
Correct answer: Initiating rapid active cooling measures.
In classic heat stroke, the body's thermoregulatory system has failed, and the core temperature is dangerously high. The single most important intervention is to begin rapid and aggressive cooling immediately to prevent further organ damage. This takes priority over all other interventions, although they may be performed simultaneously. Antipyretics are ineffective as the mechanism of hyperthermia is different from that of a fever.
AEMCA - Advanced Emergency Medical Care Assistant Medical Emergencies Questions and Answers
A 58-year-old male with a history of type 1 diabetes is found confused and diaphoretic.
His glucometer reads 2.1 mmol/L.
He is able to follow simple commands but is too disoriented to swallow safely.
An IV has been established.
According to Ontario ALS PCS, what is the most appropriate initial treatment for this patient?