EMS Pre-Hospital Care & Treatment 3 — Questions and Answers
Question 1: When treating a patient in hemorrhagic shock, which fluid resuscitation strategy is preferred in current EMS practice?
- 2 liters of normal saline rapidly
- Permissive hypotension with small boluses to maintain a systolic BP of 80-90 mmHg (Correct answer)
- Aggressive fluid resuscitation to normalize BP
- No IV fluids; transport only
Correct answer: Permissive hypotension with small boluses to maintain a systolic BP of 80-90 mmHg
Permissive hypotension (systolic ~80-90 mmHg) minimizes clot disruption and dilution of clotting factors in hemorrhagic shock.
Question 2: A diabetic patient is confused, diaphoretic, and tachycardic with a blood glucose of 42 mg/dL. The appropriate treatment is:
- Administer glucagon IM if no IV access (Correct answer)
- Administer insulin and monitor
- Administer activated charcoal
- Apply oxygen only and monitor
Correct answer: Administer glucagon IM if no IV access
Glucagon IM raises blood glucose when IV access is unavailable and the patient cannot swallow oral glucose.
Question 3: Which sign is most specific for a basilar skull fracture?
- Raccoon eyes (periorbital ecchymosis)
- Hyphema
- Battle's sign (mastoid ecchymosis) (Correct answer)
- Unequal pupils
Correct answer: Battle's sign (mastoid ecchymosis)
Battle's sign is retroauricular ecchymosis that specifically indicates basilar skull fracture.
Question 4: A patient stung by a bee develops urticaria, throat tightness, and hypotension. The first-line treatment is:
- Diphenhydramine 50 mg IV
- Epinephrine 1:1000 0.3 mg IM in the thigh (Correct answer)
- Methylprednisolone 125 mg IV
- Albuterol nebulization
Correct answer: Epinephrine 1:1000 0.3 mg IM in the thigh
Epinephrine IM is the first-line and life-saving treatment for anaphylaxis.
Question 5: During extrication, a patient's leg is trapped and has been for over 4 hours. After release, the EMT should anticipate:
- Immediate improvement in circulation
- Crush syndrome with potential hyperkalemia and renal failure (Correct answer)
- Hypoglycemia
- Respiratory arrest
Correct answer: Crush syndrome with potential hyperkalemia and renal failure
Prolonged compression causes rhabdomyolysis and release of myoglobin and potassium upon reperfusion (crush syndrome).
Question 6: Which position is preferred for a conscious patient in acute pulmonary edema?
- Supine with legs elevated
- Trendelenburg
- Sitting upright with legs dependent (Correct answer)
- Left lateral recumbent
Correct answer: Sitting upright with legs dependent
Sitting upright with legs dependent reduces venous return and eases the work of breathing in pulmonary edema.
Question 7: A patient is found unresponsive with pinpoint pupils and slow, shallow respirations. This presentation is most consistent with:
- Stimulant overdose
- Opioid overdose (Correct answer)
- Alcohol intoxication
- Diabetic ketoacidosis
Correct answer: Opioid overdose
Pinpoint pupils (miosis), respiratory depression, and altered consciousness are the classic triad of opioid toxidrome.
EMS Pre-Hospital Care & Treatment 3
When treating a patient in hemorrhagic shock, which fluid resuscitation strategy is preferred in current EMS practice?