DCAS Pre-Hospital Emergency Care 4 — Questions and Answers
Question 1: In pre-hospital care, which intravenous fluid is considered first-line for hypovolaemic shock resuscitation?
- Isotonic crystalloid (e.g., 0.9% sodium chloride or Lactated Ringer's) (Correct answer)
- Dextrose 5% in water (D5W)
- Hypotonic saline (0.45% NaCl)
- Dextrose 10% solution
Correct answer: Isotonic crystalloid (e.g., 0.9% sodium chloride or Lactated Ringer's)
Isotonic crystalloids are used for initial volume replacement in hypovolaemic shock; however, modern damage control resuscitation increasingly favours blood products for haemorrhagic shock to prevent dilutional coagulopathy.
Question 2: Intraosseous (IO) access is indicated when:
- IV access cannot be obtained within 2 attempts or 90 seconds in a critically ill patient (Correct answer)
- The patient specifically requests it
- IV access is unavailable only in paediatric patients
- The patient has no visible veins but is haemodynamically stable
Correct answer: IV access cannot be obtained within 2 attempts or 90 seconds in a critically ill patient
IO access provides rapid vascular access when IV insertion fails in time-critical emergencies, with flow rates and drug delivery comparable to central venous access — appropriate for all age groups in critical care.
Question 3: The pre-hospital management of suspected tension pneumothorax includes:
- Needle thoracostomy at the 2nd intercostal space, midclavicular line (Correct answer)
- Positive pressure ventilation without decompression
- Bilateral chest tube insertion
- Positioning the patient upright and monitoring only
Correct answer: Needle thoracostomy at the 2nd intercostal space, midclavicular line
Tension pneumothorax is immediately life-threatening and requires emergency needle thoracostomy (or finger thoracostomy in ventilated patients) to decompress the pleural space before formal chest tube insertion.
Question 4: The purpose of the 'Cincinnati Pre-hospital Stroke Scale' is to:
- Identify stroke patients using facial droop, arm drift, and speech abnormality (Correct answer)
- Calculate stroke severity for hospital triage
- Predict mortality in acute stroke
- Assess eligibility for thrombolysis in the field
Correct answer: Identify stroke patients using facial droop, arm drift, and speech abnormality
The Cincinnati scale uses three findings — facial droop (asymmetry), arm drift (one arm drifts down), and speech (slurred or wrong words) — to rapidly identify probable stroke in the pre-hospital setting.
Question 5: Which medication is the first-line treatment for suspected opioid overdose with respiratory depression in the pre-hospital setting?
- Naloxone (Narcan) — opioid antagonist (Correct answer)
- Flumazenil — benzodiazepine antagonist
- Activated charcoal
- Epinephrine 1:1000 IM
Correct answer: Naloxone (Narcan) — opioid antagonist
Naloxone competitively antagonises opioid receptors, rapidly reversing respiratory depression, sedation, and miosis caused by opioid overdose; multiple doses may be needed for long-acting opioids.
Question 6: The 'FAST' acronym used by DCAS paramedics to communicate stroke recognition stands for:
- Face drooping, Arm weakness, Speech difficulty, Time to call (Correct answer)
- First assessment, Airway management, Stabilisation, Transport
- Facial asymmetry, Altered consciousness, Sensory changes, Treatment
- Focused examination, Advanced care, Scene management, Transport
Correct answer: Face drooping, Arm weakness, Speech difficulty, Time to call
FAST (Face, Arm, Speech, Time) is the internationally adopted pre-hospital stroke recognition tool that guides paramedics to note the time of symptom onset — critical for thrombolysis eligibility.
DCAS Pre-Hospital Emergency Care 4
In pre-hospital care, which intravenous fluid is considered first-line for hypovolaemic shock resuscitation?