DHA Emergency Medical Services 4 — Questions and Answers
Question 1: A patient in anaphylactic shock has received epinephrine but remains hypotensive after 5 minutes. What is the next most appropriate intervention?
- Administer a second dose of epinephrine IM (Correct answer)
- Switch to oral antihistamines
- Apply a cold compress to the injection site
- Administer IV corticosteroids only
Correct answer: Administer a second dose of epinephrine IM
A repeat dose of epinephrine IM can be given every 5-15 minutes if the patient remains symptomatic or hemodynamically unstable.
Question 2: During a mass casualty incident (MCI), a patient tagged BLACK under START triage is found to have a weak carotid pulse. What should the EMS provider do?
- Immediately upgrade to RED and initiate resuscitation
- Reassess and retag as RED only if resources allow (Correct answer)
- Leave the patient and continue triaging others
- Administer oxygen and reassess in 10 minutes
Correct answer: Reassess and retag as RED only if resources allow
In MCI, black tags indicate expectant or deceased; upgrades are appropriate during secondary triage only when resources become available.
Question 3: Which ECG finding is MOST consistent with a right ventricular myocardial infarction?
- ST elevation in leads II, III, and aVF with ST elevation in V4R (Correct answer)
- ST depression in V1-V4 with left bundle branch block
- Peaked T waves in V1-V2 with wide QRS
- Inverted T waves in aVL and V5-V6
Correct answer: ST elevation in leads II, III, and aVF with ST elevation in V4R
Right ventricular MI classically presents with inferior ST elevation plus ST elevation in right-sided lead V4R.
Question 4: A 4-year-old child weighing 18 kg requires IO access. What is the preferred initial IO site in pediatric patients?
- Distal tibia
- Proximal tibia (anteromedial surface) (Correct answer)
- Iliac crest
- Distal femur
Correct answer: Proximal tibia (anteromedial surface)
The proximal tibia anteromedial surface is the preferred primary IO site in pediatric patients due to accessibility and low complication rates.
Question 5: When managing a suspected tension pneumothorax in the pre-hospital setting, needle decompression should be performed at which landmark?
- 2nd intercostal space, midclavicular line, superior border of the 3rd rib (Correct answer)
- 4th intercostal space, anterior axillary line
- 5th intercostal space, midaxillary line
- 3rd intercostal space, midclavicular line, inferior border of the 3rd rib
Correct answer: 2nd intercostal space, midclavicular line, superior border of the 3rd rib
Needle decompression is performed at the 2nd ICS midclavicular line, inserting above the 3rd rib to avoid the neurovascular bundle.
Question 6: A 70 kg adult patient in status epilepticus has not responded to two doses of benzodiazepine. Which agent is the preferred second-line treatment?
- Phenobarbital 20 mg/kg IV
- Levetiracetam 60 mg/kg IV (max 4500 mg)
- Valproic acid 40 mg/kg IV
- Any of the above are equally preferred per current guidelines (Correct answer)
Correct answer: Any of the above are equally preferred per current guidelines
Current guidelines (Neurocritical Care Society) consider levetiracetam, valproic acid, and fosphenytoin/phenytoin equally effective second-line agents for status epilepticus.
Question 7: Which of the following is a contraindication to the use of succinylcholine for rapid sequence intubation?
- Suspected full stomach
- Crush injury occurring 6 hours ago (Correct answer)
- Anticipated difficult airway
- Hypotension due to hemorrhagic shock
Correct answer: Crush injury occurring 6 hours ago
Succinylcholine is contraindicated after crush injuries (>6 hours) due to upregulation of acetylcholine receptors causing life-threatening hyperkalemia.
DHA Emergency Medical Services 4
A patient in anaphylactic shock has received epinephrine but remains hypotensive after 5 minutes.
What is the next most appropriate intervention?