EMS Clinical Procedures & Protocols 3 — Questions and Answers
Question 1: According to standard EMS protocols, when should spinal motion restriction (SMR) be applied?
- All trauma patients regardless of mechanism
- Patients with distracting injuries only
- Patients with mechanism of injury AND at least one spinal complaint or neurological finding (Correct answer)
- Any patient who is unresponsive
Correct answer: Patients with mechanism of injury AND at least one spinal complaint or neurological finding
Current evidence-based protocols reserve SMR for patients who have a significant mechanism of injury combined with spinal tenderness, neurological deficit, or altered mental status.
Question 2: What is the maximum duration a single CPR analysis/shock cycle should interrupt chest compressions (CCF target)?
- No more than 5 seconds
- No more than 10 seconds (Correct answer)
- No more than 15 seconds
- No more than 20 seconds
Correct answer: No more than 10 seconds
AHA guidelines recommend limiting hands-off time (peri-shock pause) to less than 10 seconds to maximize chest compression fraction.
Question 3: A patient with suspected opioid overdose is unresponsive with a respiratory rate of 4/min. What is the correct initial intervention sequence?
- Administer naloxone IM first, then support airway
- Support airway and ventilation first, then administer naloxone (Correct answer)
- Establish IV access before any other intervention
- Defibrillate if no pulse is found
Correct answer: Support airway and ventilation first, then administer naloxone
Airway management and assisted ventilation take priority in opioid OD; naloxone is given to reverse respiratory depression once ventilation is supported.
Question 4: When using a supraglottic airway (SGA) such as a King LT, tube depth is confirmed by:
- Observing chest rise and auscultating bilateral breath sounds after inflation of both cuffs (Correct answer)
- Measuring insertion depth against the patient's incisors
- Waveform capnography alone
- Chest X-ray at the receiving facility
Correct answer: Observing chest rise and auscultating bilateral breath sounds after inflation of both cuffs
Confirmation of SGA placement requires inflating both cuffs per manufacturer protocol, then verifying chest rise and bilateral breath sounds.
Question 5: During a difficult airway scenario, a BVM provides inadequate ventilation after two attempts. Per the failed airway algorithm, the next step is:
- Perform immediate surgical cricothyrotomy
- Attempt a third BVM ventilation with two-person technique
- Insert a supraglottic airway device (Correct answer)
- Administer succinylcholine and retry laryngoscopy
Correct answer: Insert a supraglottic airway device
When BVM fails, the failed airway algorithm directs placement of a supraglottic airway before progressing to a surgical airway.
Question 6: Which IV fluid rate is appropriate for a hypotensive trauma patient prior to hemorrhage control (permissive hypotension strategy)?
- 2 L bolus wide open
- Titrate to a systolic BP of 80–90 mmHg (Correct answer)
- Titrate to a systolic BP of 120 mmHg
- No fluids until surgical hemorrhage control is achieved
Correct answer: Titrate to a systolic BP of 80–90 mmHg
Permissive hypotension targets a systolic BP of 80–90 mmHg in penetrating trauma to limit dilution of clotting factors while maintaining minimal perfusion.
Question 7: What is the correct compression-to-ventilation ratio for two-rescuer CPR on an adult patient WITHOUT an advanced airway in place?
- 15:2
- 30:2 (Correct answer)
- 30:1
- 15:1
Correct answer: 30:2
The AHA-recommended ratio for two-rescuer adult CPR without an advanced airway is 30 compressions to 2 ventilations.
EMS Clinical Procedures & Protocols 3
According to standard EMS protocols, when should spinal motion restriction (SMR) be applied?