CPR Emergency Medical Procedures & Protocols 3 — Questions and Answers
Question 1: A trauma patient has a systolic BP of 70 mmHg, heart rate of 130, and is unresponsive. Which fluid resuscitation strategy is preferred in penetrating torso trauma?
- 2 L crystalloid bolus immediately
- Permissive hypotension targeting SBP 80-90 mmHg (Correct answer)
- Normal saline at 1 L/hr maintenance
- No fluids until surgical hemorrhage control
Correct answer: Permissive hypotension targeting SBP 80-90 mmHg
Permissive hypotension (targeting SBP 80-90 mmHg) is preferred in penetrating torso trauma to avoid diluting clotting factors while maintaining perfusion.
Question 2: Which finding on a 12-lead ECG is MOST indicative of an ST-elevation myocardial infarction (STEMI) requiring immediate cath lab activation?
- Sinus tachycardia with T-wave inversions in V1-V3
- ST elevation ≥1 mm in two or more contiguous leads (Correct answer)
- Q waves in leads II, III, aVF
- Left bundle branch block with rate 90 bpm
Correct answer: ST elevation ≥1 mm in two or more contiguous leads
ST elevation ≥1 mm in two or more contiguous leads is the hallmark ECG criterion for STEMI requiring emergent reperfusion therapy.
Question 3: During a high-priority trauma transport, a patient's SpO2 drops from 98% to 82% with diminished breath sounds on the right. What is the MOST likely diagnosis?
- Pulmonary edema from fluid overload
- Right-sided tension pneumothorax (Correct answer)
- Mucus plug causing right mainstem occlusion
- Esophageal intubation
Correct answer: Right-sided tension pneumothorax
Unilateral diminished breath sounds with acute SpO2 decline in a trauma patient is tension pneumothorax until proven otherwise.
Question 4: What is the correct dose of epinephrine administered during adult cardiac arrest per current AHA ACLS protocol?
- 0.5 mg IV every 5 minutes
- 1 mg IV every 3-5 minutes (Correct answer)
- 2 mg IV every 10 minutes
- 1 mg IV once after ROSC
Correct answer: 1 mg IV every 3-5 minutes
Epinephrine 1 mg IV is given every 3-5 minutes during adult cardiac arrest as the primary vasopressor per AHA ACLS guidelines.
Question 5: A 6-year-old child (22 kg) requires IV fluid resuscitation for dehydration. What is the correct initial bolus volume?
- 110 mL normal saline
- 220 mL normal saline (Correct answer)
- 440 mL normal saline
- 500 mL normal saline
Correct answer: 220 mL normal saline
The standard pediatric fluid bolus is 20 mL/kg, so a 22 kg child receives 440 mL — but the initial safe bolus is commonly administered as 10-20 mL/kg; 20 mL/kg = 440 mL.
Question 6: Which of the following is the MOST reliable field indicator of successful endotracheal intubation?
- Symmetric chest rise and fall
- Continuous waveform capnography (Correct answer)
- Condensation visible in the tube
- Absence of gastric gurgling sounds
Correct answer: Continuous waveform capnography
Continuous waveform capnography (ETCO2) is the gold standard for confirming and continuously monitoring correct endotracheal tube placement.
Question 7: In the management of a patient with severe anaphylaxis, epinephrine should be administered via which route FIRST?
- Subcutaneous injection in the deltoid
- Intramuscular injection in the anterolateral thigh (Correct answer)
- Intravenous bolus of 1 mg
- Sublingual absorption
Correct answer: Intramuscular injection in the anterolateral thigh
Intramuscular epinephrine in the anterolateral thigh achieves faster and more reliable absorption than subcutaneous injection in anaphylaxis.
CPR Emergency Medical Procedures & Protocols 3
A trauma patient has a systolic BP of 70 mmHg, heart rate of 130, and is unresponsive.
Which fluid resuscitation strategy is preferred in penetrating torso trauma?