CEP Medical Emergencies & Patient Transport 3 — Questions and Answers
Question 1: A conscious patient presents with urticaria, wheezing, hypotension, and a history of bee sting 10 minutes ago. What is the first-line treatment?
- Diphenhydramine 50 mg IV
- Methylprednisolone 125 mg IV
- Epinephrine 0.3 mg IM to the lateral thigh (Correct answer)
- Albuterol nebulization
Correct answer: Epinephrine 0.3 mg IM to the lateral thigh
Epinephrine IM is the first-line and potentially life-saving treatment for anaphylaxis, addressing bronchoconstriction and vasodilation simultaneously.
Question 2: During transport, a patient with a suspected pulmonary embolism deteriorates with decreasing BP and SpO2. Which additional intervention is most appropriate?
- Aggressive IV fluid boluses of 2 L NS
- Nitroglycerin 0.4 mg SL for preload reduction
- Cautious fluid resuscitation and rapid transport to ED (Correct answer)
- Immediate needle decompression of the chest
Correct answer: Cautious fluid resuscitation and rapid transport to ED
Massive PE management prehospital is supportive with cautious fluids and rapid transport; aggressive fluids can worsen right heart strain.
Question 3: Which finding on a 12-lead ECG is most consistent with a right ventricular infarction?
- ST elevation in leads V1–V4
- ST elevation in leads II, III, and aVF with ST elevation in V4R (Correct answer)
- ST depression in leads I and aVL
- New left bundle branch block
Correct answer: ST elevation in leads II, III, and aVF with ST elevation in V4R
RV infarction typically accompanies inferior STEMI and is confirmed by ST elevation in right-sided lead V4R.
Question 4: A seizing patient has been actively seizing for 8 minutes. IV access is unavailable. Which benzodiazepine route is most appropriate?
- Oral diazepam
- Rectal diazepam or intranasal/IM midazolam (Correct answer)
- Subcutaneous lorazepam
- Wait for IV access before administering any medication
Correct answer: Rectal diazepam or intranasal/IM midazolam
Intranasal or IM midazolam and rectal diazepam are effective alternative routes when IV access is unavailable in status epilepticus.
Question 5: A patient with end-stage renal disease presents with peaked T waves, wide QRS, and a serum potassium of 7.2 mEq/L. Which medication should be given first?
- Sodium bicarbonate
- Calcium chloride or calcium gluconate (Correct answer)
- Albuterol nebulization
- Sodium polystyrene sulfonate
Correct answer: Calcium chloride or calcium gluconate
Calcium stabilizes the myocardial membrane immediately in hyperkalemia-induced cardiac toxicity, buying time for other interventions.
Question 6: When transporting a patient in shock who requires both fluid resuscitation and vasopressors, which vasopressor is recommended as first-line for septic shock?
- Epinephrine
- Vasopressin
- Norepinephrine (Correct answer)
- Dopamine
Correct answer: Norepinephrine
Norepinephrine is the first-line vasopressor for septic shock due to its reliable vasoconstrictive effect with minimal tachycardia.
Question 7: A patient with suspected carbon monoxide poisoning has SpO2 of 99% on pulse oximetry. How should you interpret this reading?
- The patient is adequately oxygenated and CO poisoning is unlikely
- Pulse oximetry is unreliable in CO poisoning as it cannot distinguish oxyhemoglobin from carboxyhemoglobin (Correct answer)
- CO poisoning always presents with low SpO2 readings
- Administer supplemental O2 only if SpO2 drops below 95%
Correct answer: Pulse oximetry is unreliable in CO poisoning as it cannot distinguish oxyhemoglobin from carboxyhemoglobin
Standard pulse oximetry cannot differentiate carboxyhemoglobin from oxyhemoglobin, giving falsely normal readings in CO poisoning.
CEP Medical Emergencies & Patient Transport 3
A conscious patient presents with urticaria, wheezing, hypotension, and a history of bee sting 10 minutes ago.
What is the first-line treatment?