A-EMCA Theory Exam — Questions and Answers

Question 1: Which oxygen delivery device provides the highest concentration of oxygen for a spontaneously breathing patient?

Venturi mask
Nasal cannula
Non-rebreather mask (Correct answer)
Simple face mask

Correct answer: Non-rebreather mask

A non-rebreather mask with a reservoir bag can deliver 90–95% oxygen when properly fitted and flow rate is adequate.

Question 2: You respond to a 74-year-old male who has fallen. He has an obvious deformity to his right wrist and is in significant pain, but he is refusing assessment and transport. He is alert, knows his name, location, and the year, but cannot recall the events leading up to the fall. Under Ontario's Health Care Consent Act, what is the most appropriate action for the paramedic?

Contact the base hospital physician to discuss the patient's capacity to refuse treatment. (Correct answer)
Accept the patient's refusal, have him sign the refusal form, and clear the scene.
Treat the patient under the principle of implied consent, as his injury is significant.
Request police assistance to transport the patient to the hospital against his will.

Correct answer: Contact the base hospital physician to discuss the patient's capacity to refuse treatment.

The patient's inability to recall the event leading to his injury, despite being alert and oriented to person, place, and time, raises legitimate questions about his capacity to appreciate the consequences of his decision. Under the Health Care Consent Act (HCCA), a person must be able to understand the information relevant to making a treatment decision and appreciate the reasonably foreseeable consequences of that decision. When capacity is in doubt, paramedics in Ontario should contact the base hospital physician for guidance and a formal determination if necessary. [2]

Question 3: A patient with type 1 diabetes who has missed meals presents with confusion, diaphoresis, and a blood glucose of 40 mg/dL. After oral glucose fails, what is the next intervention?

Administer 1 mg glucagon IM (Correct answer)
Administer 100 mg thiamine IV
Administer 2 mg naloxone IM
Perform a 500 mL NS bolus

Correct answer: Administer 1 mg glucagon IM

When a hypoglycemic patient cannot protect their airway for oral glucose, 1 mg glucagon IM stimulates hepatic glycogenolysis to raise blood sugar.

Question 4: A 58-year-old male with a history of type 1 diabetes is found confused and diaphoretic. His glucometer reads 2.1 mmol/L. He is able to follow simple commands but is too disoriented to swallow safely. An IV has been established. According to Ontario ALS PCS, what is the most appropriate initial treatment for this patient?

Administer 25 grams of Dextrose 50% (D50W) slow IV push.
Encourage the patient to drink a glass of orange juice.
Administer 10 grams of Dextrose 10% (D10W) slow IV push, and reassess. (Correct answer)
Administer 1 mg of Glucagon intramuscularly.

Correct answer: Administer 10 grams of Dextrose 10% (D10W) slow IV push, and reassess.

Current Ontario ALS PCS guidelines favor D10W over D50W for treating hypoglycemia due to a lower risk of extravasation injury and rebound hypoglycemia. D10W is administered in 10-gram aliquots, followed by a reassessment of the patient's blood glucose level and clinical status. Glucagon is an alternative if IV access cannot be obtained, and oral glucose is inappropriate as the patient cannot swallow safely.

Question 5: A patient in compensated hemorrhagic shock will most likely demonstrate which early sign?

Hypotension with bradycardia
Widened pulse pressure
Tachycardia with normal blood pressure (Correct answer)
Decreased respiratory rate

Correct answer: Tachycardia with normal blood pressure

In compensated shock the body maintains blood pressure through tachycardia and vasoconstriction, so tachycardia is the earliest reliable indicator.

Question 6: What is the correct ventilation rate for an adult patient who has a pulse but is apneic?

8–10 breaths per minute
20–24 breaths per minute
16–20 breaths per minute
10–12 breaths per minute (Correct answer)

Correct answer: 10–12 breaths per minute

Current guidelines recommend 10–12 breaths per minute (one breath every 5–6 seconds) for an adult with a pulse but no respirations.

Question 7: A patient is found unconscious in a closed garage with a running engine. What pulse oximetry reading would you most likely expect?

SpO2 of 98–100% (falsely normal) (Correct answer)
SpO2 of 80–85% (moderately low)
SpO2 of 60–65% (critically low)
SpO2 of 70–75% (severely low)

Correct answer: SpO2 of 98–100% (falsely normal)

Standard pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin, giving a falsely normal or near-normal SpO2 reading in carbon monoxide poisoning.

Question 8: Epinephrine 1 mg IV/IO is administered during cardiac arrest. How frequently should this dose be repeated?

Every 2 minutes
Every 5–10 minutes
Only once during the arrest
Every 3–5 minutes (Correct answer)

Correct answer: Every 3–5 minutes

AHA ACLS guidelines recommend 1 mg epinephrine IV/IO every 3–5 minutes during cardiac arrest.

Question 9: Which of the following defines a hypertensive emergency, distinguishing it from hypertensive urgency?

The presence of acute end-organ damage. (Correct answer)
Symptoms such as headache and anxiety.
A systolic blood pressure greater than 220 mmHg.
A diastolic blood pressure greater than 120 mmHg.

Correct answer: The presence of acute end-organ damage.

A hypertensive emergency is defined by a severe elevation in blood pressure (e.g., SBP >180 or DBP >120) that is associated with evidence of new or worsening target end-organ damage, such as stroke, myocardial infarction, acute renal failure, or pulmonary edema. Hypertensive urgency involves a similar BP elevation but without the acute end-organ damage.

Question 10: A gravid patient at 38 weeks is involved in a motor vehicle collision and is unresponsive. Which positioning change is critical during resuscitation?

Right lateral tilt to facilitate airway management
Supine with legs elevated 30 degrees
Left lateral uterine displacement to relieve aortocaval compression (Correct answer)
Trendelenburg position to improve cerebral perfusion

Correct answer: Left lateral uterine displacement to relieve aortocaval compression

The gravid uterus compresses the inferior vena cava and aorta in the supine position; manual left uterine displacement improves venous return and cardiac output.

Question 11: Which opioid analgesic has the longest duration of action and highest risk for prolonged respiratory depression?

Fentanyl
Hydromorphone
Morphine
Methadone (Correct answer)

Correct answer: Methadone

Methadone has an extremely long half-life (24-36+ hours), putting patients at risk for delayed respiratory depression after initial dosing.

Question 12: A patient with known epilepsy has been seizing continuously for 8 minutes. This condition is classified as:

Absence seizure
Postictal state
Simple partial seizure
Status epilepticus (Correct answer)

Correct answer: Status epilepticus

Status epilepticus is defined as a seizure lasting more than 5 minutes or two or more seizures without regaining consciousness between them.

Question 13: Which sign differentiates meningitis from a simple headache in a patient with fever and neck stiffness?

Kernig's sign
Both Kernig's and Brudzinski's signs (Correct answer)
Babinski's sign
Brudzinski's sign

Correct answer: Both Kernig's and Brudzinski's signs

Both Kernig's sign (resistance to knee extension with hip flexed) and Brudzinski's sign (involuntary hip flexion with neck flexion) indicate meningeal irritation.

Question 14: When using the Cincinnati Prehospital Stroke Scale, which THREE components are assessed?

Visual fields, reflexes, and coordination
Pupil response, grip strength, and gait
Blood pressure, heart rate, and GCS
Facial droop, arm drift, and speech (Correct answer)

Correct answer: Facial droop, arm drift, and speech

The Cincinnati Prehospital Stroke Scale evaluates facial droop, arm drift, and abnormal speech to rapidly identify stroke in the field.

Question 15: When performing a rapid trauma assessment on an unconscious patient, the AEMCA should assess the head for:

Glasgow Coma Scale components only
Only visible lacerations and active bleeding
Deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, and swelling (DCAP-BTLS) (Correct answer)
Pupillary response and blood pressure

Correct answer: Deformities, contusions, abrasions, punctures, burns, tenderness, lacerations, and swelling (DCAP-BTLS)

DCAP-BTLS is the systematic mnemonic used during the rapid trauma assessment to evaluate each body region for Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations, and Swelling.

Question 16: Which antidote is used to reverse benzodiazepine overdose?

Flumazenil (Correct answer)
N-acetylcysteine
Physostigmine
Naloxone

Correct answer: Flumazenil

Flumazenil is a competitive benzodiazepine receptor antagonist that reverses CNS and respiratory depression caused by benzodiazepine overdose.

Question 17: A patient delivers a preterm infant at approximately 32 weeks. Beyond airway management and warmth, which additional measure is most important for this neonate?

Delay cord clamping for at least 5 minutes
Stimulate aggressively by rubbing the trunk
Administer prophylactic oxygen at 100%
Wrap in a polyethylene plastic bag or thermal blanket to prevent heat loss (Correct answer)

Correct answer: Wrap in a polyethylene plastic bag or thermal blanket to prevent heat loss

Preterm neonates are highly susceptible to hypothermia; wrapping in a polyethylene bag (without drying) is recommended to maintain temperature in infants under 32 weeks.

Question 18: When is a nasal cannula at 6 L/min appropriate?

For a patient with mild hypoxia who is breathing adequately (Correct answer)
For a patient in severe respiratory distress needing maximum FiO2
For a patient requiring controlled low-concentration oxygen
For any patient requiring supplemental oxygen

Correct answer: For a patient with mild hypoxia who is breathing adequately

Nasal cannula at 2–6 L/min is appropriate for patients with mild to moderate hypoxia who are breathing adequately on their own.

Question 19: A patient with a spinal cord injury at C4 requires which immediate intervention?

Dopamine infusion for neurogenic shock
IV corticosteroids
Spinal immobilization only
Airway management and ventilatory support (Correct answer)

Correct answer: Airway management and ventilatory support

C4 injuries can paralyze the diaphragm (phrenic nerve roots C3–C5), making airway and ventilatory support immediately critical.

Question 20: What is the mechanism of action of physostigmine when used to treat anticholinergic toxicity?

Directly stimulates muscarinic cholinergic receptors
Competes directly with anticholinergic agents at the receptor
Blocks alpha-adrenergic receptors peripherally
Inhibits acetylcholinesterase, increasing synaptic acetylcholine levels (Correct answer)

Correct answer: Inhibits acetylcholinesterase, increasing synaptic acetylcholine levels

Physostigmine inhibits acetylcholinesterase, preventing breakdown of acetylcholine and thereby increasing its concentration to overcome the anticholinergic blockade at muscarinic receptors.

Question 21: During rapid sequence intubation of a trauma patient with a suspected full stomach, which step prevents gastric content aspiration?

Sellick's maneuver (cricoid pressure) during induction (Correct answer)
Administering metoclopramide to speed gastric emptying
Positioning the patient in Trendelenburg before intubation
Using a King airway as a first-line device

Correct answer: Sellick's maneuver (cricoid pressure) during induction

Cricoid pressure compresses the esophagus against the vertebral body to reduce passive regurgitation during RSI in patients at aspiration risk.

Question 22: Which ECG finding differentiates Wolff-Parkinson-White (WPW) syndrome from other causes of SVT?

Prolonged PR interval and wide QRS
Short PR interval and delta wave (Correct answer)
Absent P waves and irregular rhythm
ST depression in lateral leads

Correct answer: Short PR interval and delta wave

WPW is characterized by a short PR interval (<120 ms) and slurred upstroke of the QRS (delta wave) due to accessory pathway pre-excitation.

Question 23: A scuba diver surfaces rapidly and complains of joint pain, rash, and dyspnea. What condition should be suspected?

Decompression sickness (the bends) (Correct answer)
Arterial gas embolism
Pulmonary barotrauma
Nitrogen narcosis

Correct answer: Decompression sickness (the bends)

Decompression sickness results from dissolved nitrogen forming bubbles in tissues and blood during rapid ascent, causing joint pain, rash, and respiratory symptoms.

Question 24: A patient has frostbite to all toes. The toes are white, waxy, and insensate. What is the correct prehospital management?

Rewarm immediately in warm water in the field
Rub the toes vigorously to restore circulation
Apply ice to reduce swelling
Protect from further freezing and do not rewarm if risk of refreezing exists (Correct answer)

Correct answer: Protect from further freezing and do not rewarm if risk of refreezing exists

Refreezing after thawing causes severe additional injury; prehospital providers should protect frostbitten areas and delay rewarming until a controlled environment is available.

Question 25: A 70-year-old male presents with tearing chest pain radiating to the back, unequal blood pressures in both arms, and a widened mediastinum on CXR. The most likely diagnosis is:

Tension pneumothorax
STEMI with posterior extension
Aortic dissection (Correct answer)
Cardiac tamponade

Correct answer: Aortic dissection

Tearing back pain, blood pressure differential between arms, and widened mediastinum are hallmarks of aortic dissection.

Question 26: Which of the following best describes the Somogyi effect in diabetic patients?

Dawn phenomenon caused by growth hormone surge
Morning hyperglycemia due to insufficient evening insulin
Rebound hyperglycemia following nocturnal hypoglycemia (Correct answer)
Post-meal hyperglycemia despite adequate insulin dosing

Correct answer: Rebound hyperglycemia following nocturnal hypoglycemia

The Somogyi effect is rebound hyperglycemia that occurs after nocturnal hypoglycemia triggers counter-regulatory hormone release.

Question 27: A 30-year-old male has a gunshot wound to the thigh with significant hemorrhage. He is anxious and confused, with a heart rate of 135 bpm, a respiratory rate of 34, and a blood pressure of 88/60 mmHg. Based on these findings, which class of hemorrhagic shock is he most likely in?

Class II
Class IV
Class I
Class III (Correct answer)

Correct answer: Class III

Class III hemorrhagic shock is characterized by a blood volume loss of 30-40% (1500-2000 mL). This stage marks the transition to decompensated shock, where the body's compensatory mechanisms fail. Key signs include a heart rate over 120 bpm, respiratory rate of 30-40, a significant drop in systolic blood pressure, and altered mental status such as confusion or anxiety. The patient's vitals and presentation align perfectly with this classification.

Question 28: A patient with anaphylaxis receives epinephrine 0.3 mg IM but shows no improvement after 5 minutes. The correct next step is:

Administer methylprednisolone 125 mg IV
Switch to IV diphenhydramine 50 mg
Give a second dose of epinephrine 0.3 mg IM (Correct answer)
Give albuterol via nebulizer and reassess

Correct answer: Give a second dose of epinephrine 0.3 mg IM

Epinephrine can be repeated every 5-15 minutes; it remains the first-line treatment and should be re-dosed before considering adjunct therapies.

Question 29: Which standard is used to determine whether an AEMCA's actions were legally appropriate in a negligence lawsuit?

The community standard of a physician in the same region
The highest level of care achievable with available resources
What a reasonably prudent AEMCA with equivalent training would do in the same situation (Correct answer)
What the medical director would personally have done on scene

Correct answer: What a reasonably prudent AEMCA with equivalent training would do in the same situation

The 'reasonably prudent provider' standard compares the AEMCA's actions to those of a similarly trained provider under the same circumstances.

Question 30: At what altitude does acute mountain sickness (AMS) typically begin to manifest?

Above 2,500 meters (8,200 ft) (Correct answer)
500–1,000 meters (1,640–3,281 ft)
Above 1,000 meters (3,281 ft)
Only above 5,000 meters (16,404 ft)

Correct answer: Above 2,500 meters (8,200 ft)

AMS typically begins to manifest above 2,500 meters, where partial pressure of oxygen becomes significantly reduced.

Question 31: Which vasopressor works by releasing norepinephrine from sympathetic nerve terminals rather than directly stimulating adrenergic receptors?

Epinephrine
Ephedrine (Correct answer)
Norepinephrine
Dopamine

Correct answer: Ephedrine

Ephedrine is an indirect-acting sympathomimetic that displaces norepinephrine from vesicles at sympathetic nerve terminals.

Question 32: A patient who was in a high-speed MVA is now hypotensive and tachycardic with abdominal rigidity and guarding. On the way to the trauma center, IV access cannot be established peripherally. What is the next best vascular access option?

Femoral vein cutdown
External jugular vein catheterization
Intraosseous access at the proximal tibia or humeral head (Correct answer)
Delay fluids until arrival at the ED

Correct answer: Intraosseous access at the proximal tibia or humeral head

Intraosseous access provides rapid, reliable vascular access equivalent to central IV access when peripheral access fails in a critical patient.

Question 33: A construction worker is trapped under debris for 2 hours. During extrication, what phenomenon can occur that may cause sudden cardiac arrest?

Aortic rupture
Crush syndrome with potassium release causing dysrhythmia (Correct answer)
Tension pneumothorax
Air embolism

Correct answer: Crush syndrome with potassium release causing dysrhythmia

Release of a crush injury frees myoglobin, potassium, and lactic acid into circulation (reperfusion), potentially triggering fatal dysrhythmias.

Question 34: You are managing a patient following a traumatic injury and suspect a cervical spine injury. The patient is unconscious and requires airway management. Which manual maneuver is most appropriate for opening the airway in this patient?

Head-tilt, chin-lift
Jaw-thrust maneuver (Correct answer)
Flexion of the neck
Head-tilt, neck-lift

Correct answer: Jaw-thrust maneuver

In a patient with a suspected cervical spine injury, the jaw-thrust maneuver is the recommended technique for opening the airway. This method avoids extending or flexing the neck, minimizing the risk of exacerbating a potential spinal cord injury. The head-tilt, chin-lift is contraindicated in this scenario.

Question 35: What is the prehospital treatment for a patient with severe decompression sickness?

Immediate recompression by returning to depth
High-flow 100% oxygen and rapid transport to a hyperbaric facility (Correct answer)
IV morphine and ice to affected joints
Aspirin and fluid restriction

Correct answer: High-flow 100% oxygen and rapid transport to a hyperbaric facility

100% oxygen accelerates nitrogen washout and reduces bubble size; hyperbaric oxygen therapy is definitive treatment for DCS.

Question 36: A patient's Glasgow Coma Scale score is calculated at 3. This indicates:

Mild confusion with intact reflexes
Normal neurological function
Moderate brain injury with purposeful movement
No meaningful response — deep coma (Correct answer)

Correct answer: No meaningful response — deep coma

A GCS of 3 is the minimum possible score, indicating no eye opening, no verbal response, and no motor response, consistent with deep coma.

Question 37: A postictal patient becomes increasingly unresponsive 20 minutes after a witnessed tonic-clonic seizure. What is the most concerning possibility?

Vagal syncope
Normal postictal state
Todd's paralysis
Status epilepticus (Correct answer)

Correct answer: Status epilepticus

Failure to regain consciousness after a seizure raises concern for status epilepticus, which requires immediate intervention.

Question 38: A patient presents with confusion, fever (103°F), muscle rigidity, and autonomic instability after starting a new antipsychotic. What condition should be suspected?

Anticholinergic toxicity
Neuroleptic malignant syndrome (Correct answer)
Malignant hyperthermia
Serotonin syndrome

Correct answer: Neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to antipsychotics characterized by hyperthermia, muscle rigidity, altered mental status, and autonomic dysfunction.

Question 39: A 4-year-old with a history of asthma presents with severe respiratory distress, diffuse wheezing, accessory muscle use, and SpO2 of 89%. After two albuterol treatments, minimal improvement is noted. What medication should be considered next?

Diphenhydramine IV
Epinephrine 1:1,000 SQ 0.01 mg/kg
Ipratropium bromide nebulized (Correct answer)
Magnesium sulfate IV

Correct answer: Ipratropium bromide nebulized

Ipratropium bromide (an anticholinergic) is added to albuterol for moderate-to-severe pediatric asthma exacerbations unresponsive to initial beta-agonist therapy.

Question 40: Which electrolyte abnormality is most associated with severe rhabdomyolysis following crush injury?

Hypocalcemia
Hyponatremia
Hyperkalemia (Correct answer)
Hypomagnesemia

Correct answer: Hyperkalemia

Rhabdomyolysis releases intracellular potassium from damaged muscle cells, causing life-threatening hyperkalemia.

Question 41: A 45-year-old diabetic patient is found unresponsive. Blood glucose reads 32 mg/dL. After administering dextrose, the patient does not improve. What should you consider?

Concurrent neurological emergency such as stroke (Correct answer)
Administer more dextrose immediately
The glucometer is inaccurate
Insulin overdose requiring glucagon

Correct answer: Concurrent neurological emergency such as stroke

When hypoglycemia correction does not restore consciousness, a simultaneous neurological emergency such as stroke or head injury must be considered.

Question 42: You are treating a 75-year-old female with a history of congestive heart failure (CHF) who presents with severe dyspnea, crackles in all lung fields, and pitting edema in her lower extremities. Which of the following prehospital interventions is most appropriate for managing her acute pulmonary edema?

Placing the patient in a supine position
Administering nitroglycerin and applying Continuous Positive Airway Pressure (CPAP) (Correct answer)
Administering a 500 mL normal saline fluid bolus
Preparing for immediate defibrillation

Correct answer: Administering nitroglycerin and applying Continuous Positive Airway Pressure (CPAP)

For a patient with acute cardiogenic pulmonary edema secondary to CHF, the treatment goals are to reduce preload and afterload and improve oxygenation. Nitroglycerin is a vasodilator that reduces preload, and CPAP provides continuous pressure to keep alveoli open, improving gas exchange by pushing fluid out of the alveolar space.

Question 43: When assessing skin color, temperature, and condition (CTC) in a patient, pale, cool, and diaphoretic skin most likely indicates:

Fever or hyperthermia
Allergic reaction with vasodilation
Hyperglycemia
Shock or hypoperfusion (Correct answer)

Correct answer: Shock or hypoperfusion

Pale, cool, diaphoretic skin is the classic presentation of sympathetic activation in shock, indicating hypoperfusion.

Question 44: Which finding best differentiates a seizure from syncope in a prehospital patient?

Pallor and diaphoresis
Loss of consciousness
Postictal confusion lasting several minutes (Correct answer)
Brief clonic jerking at syncopal onset

Correct answer: Postictal confusion lasting several minutes

A postictal state with prolonged confusion is characteristic of seizure and does not occur after a simple syncopal episode.

Question 45: Which position is recommended for a conscious patient in hemorrhagic shock with no suspected spinal injury?

Left lateral recumbent
Trendelenburg (legs elevated 10–15°) (Correct answer)
Semi-Fowler's (30–45° head elevation)
Prone position

Correct answer: Trendelenburg (legs elevated 10–15°)

Trendelenburg or supine with legs elevated encourages venous return to the core circulation in hypotensive patients.

Question 46: A patient presents with altered mental status, fever, headache, and a non-blanching petechial rash. What is the priority action?

Order a CT head before any intervention
Obtain a lumbar puncture before any treatment
Isolate the patient and wait for culture results
Administer antibiotics immediately without delay (Correct answer)

Correct answer: Administer antibiotics immediately without delay

Meningococcal meningitis with septicemia requires immediate antibiotics; delaying treatment for imaging or lumbar puncture significantly increases mortality.

Question 47: A 3-year-old presents with sudden onset of stridor and cyanosis while eating. The child is conscious but cannot cough effectively. What is the most appropriate intervention?

Initiate immediate positive pressure ventilation via BVM
Perform blind finger sweeps of the oropharynx
Administer five back blows followed by five abdominal thrusts (Heimlich maneuver) (Correct answer)
Perform five back blows followed by five chest thrusts

Correct answer: Administer five back blows followed by five abdominal thrusts (Heimlich maneuver)

For a conscious child over 1 year with an ineffective cough and severe foreign body airway obstruction, alternating back blows and abdominal thrusts (Heimlich maneuver) are indicated.

Question 48: When ventilating a patient with a suspected tension pneumothorax, which ventilation change would WORSEN the condition?

Increasing tidal volume and rate (overventilation) (Correct answer)
Decreasing respiratory rate
Using a PEEP valve
Reducing inspiratory time

Correct answer: Increasing tidal volume and rate (overventilation)

Overventilation increases intrathoracic pressure, which worsens tension pneumothorax by further compressing mediastinal structures.

Question 49: A patient at 22 weeks gestation reports painless, blood-tinged mucus discharge after a vaginal exam. She has no contractions. This MOST likely represents:

Placenta previa hemorrhage
Active labor requiring immediate delivery
Amniotic fluid mixed with blood
Bloody show signaling cervical changes (Correct answer)

Correct answer: Bloody show signaling cervical changes

Blood-tinged mucus plug discharge (bloody show) reflects cervical effacement and dilation and does not necessarily indicate an emergency by itself.

Question 50: You are triaging patients at a mass casualty incident. You encounter an adult victim who is not breathing. After manually opening the patient's airway, they remain apneic. According to the Simple Triage and Rapid Treatment (START) system, what is the correct action?

Tag the patient as RED (Immediate), and begin bag-valve-mask ventilations.
Tag the patient as BLACK (Deceased/Expectant) and move to the next patient. (Correct answer)
Re-attempt to open the airway a second time before making a triage decision.
Tag the patient as YELLOW (Delayed) and place them in the recovery position.

Correct answer: Tag the patient as BLACK (Deceased/Expectant) and move to the next patient.

In the START triage system, an adult patient who does not begin breathing after a single attempt to open their airway is categorized as BLACK (Deceased/Expectant). The goal of MCI triage is to do the most good for the greatest number of people, and resources are not allocated to patients who are apneic after basic airway maneuvers.

Question 51: When performing a primary survey on a trauma patient, which of the following actions is the highest priority after confirming a patent airway?

Obtaining a SAMPLE history.
Performing a detailed neurological exam.
Assessing the adequacy of breathing and ventilation. (Correct answer)
Controlling minor extremity bleeding.

Correct answer: Assessing the adequacy of breathing and ventilation.

The primary survey follows the systematic <C>ABCDE approach to identify and manage immediate life threats. [11, 21, 23] After ensuring the airway ('A') is patent, the next critical step is to assess breathing ('B') and provide interventions like oxygenation or ventilation if needed. [24] The other actions are part of the secondary survey or are of lower priority.

Question 52: When selecting an OPA size, the correct method is to measure from the:

Incisors to the angle of the jaw
Tip of the nose to the earlobe
Center of the mouth to the earlobe
Corner of the mouth to the earlobe (Correct answer)

Correct answer: Corner of the mouth to the earlobe

OPA size is estimated by measuring from the corner of the mouth to the earlobe (or center of mouth to angle of jaw).

Question 53: When responding to a scene with a potential active shooter, EMS providers should:

Follow law enforcement directly into the hot zone
Enter immediately to care for the wounded
Stage in a warm zone and wait for law enforcement to secure the scene (Correct answer)
Attempt to disarm the shooter if the opportunity arises

Correct answer: Stage in a warm zone and wait for law enforcement to secure the scene

EMS should stage in the warm zone and only enter once law enforcement has rendered the area safe.

Question 54: Decerebrate posturing (extensor posturing) in a head-injured patient indicates injury at which level?

Spinal cord
Cerebellum
Cortex
Brainstem (midbrain/pons) (Correct answer)

Correct answer: Brainstem (midbrain/pons)

Decerebrate posturing reflects brainstem injury at the midbrain or pons level and indicates severe neurological compromise.

Question 55: A 72-year-old is in cardiogenic shock after a large MI. Which hemodynamic pattern is expected?

Low BP, high CO, low SVR
Low BP, low CO, high SVR (Correct answer)
High BP, low CO, low SVR
High BP, high CO, low SVR

Correct answer: Low BP, low CO, high SVR

Cardiogenic shock is characterized by low cardiac output from pump failure and compensatory peripheral vasoconstriction (high SVR) causing low blood pressure.

Question 56: In the context of a major trauma patient, which of the following correctly identifies the components of the 'lethal triad' of trauma?

Hypothermia, Coagulopathy, Acidosis (Correct answer)
Bradycardia, Hypocapnia, Alkalosis
Hypotension, Hypoxia, Hyperglycemia
Hypertension, Tachycardia, Hyperthermia

Correct answer: Hypothermia, Coagulopathy, Acidosis

The lethal triad is a physiological cascade that occurs in severely injured patients. It consists of hypothermia (low body temperature), coagulopathy (impaired blood clotting), and acidosis (increased blood acidity). Each component worsens the others, creating a vicious cycle that significantly increases mortality if not managed aggressively.

Question 57: Which of the following is the correct landmark for adult IO (intraosseous) access using the tibial site?

Lateral aspect of the distal tibia, 2 cm above the medial malleolus
The tibial tuberosity directly
Proximal tibia, 2 cm below the tibial tuberosity on the flat anteromedial surface (Correct answer)
Posterior aspect of the proximal tibia

Correct answer: Proximal tibia, 2 cm below the tibial tuberosity on the flat anteromedial surface

The proximal tibia IO site is 2 cm below the tibial tuberosity on the flat anteromedial surface, away from the growth plate.

Question 58: Which sign indicates compartment syndrome in an injured extremity?

Weak but palpable distal pulse
Ecchymosis overlying the fracture site
Crepitus on palpation
Pain with passive stretch of muscles in the affected compartment (Correct answer)

Correct answer: Pain with passive stretch of muscles in the affected compartment

Pain out of proportion with passive stretch of muscles in the compartment is the earliest and most sensitive sign of compartment syndrome.

Question 59: Which ECG change is an early indicator of right ventricular strain in a patient with massive pulmonary embolism?

S1Q3T3 pattern (Correct answer)
Prominent U waves in V2-V4
ST elevation in leads II, III, aVF
Delta waves in precordial leads

Correct answer: S1Q3T3 pattern

The S1Q3T3 pattern (S wave in lead I, Q wave and T-wave inversion in lead III) is a classic, though non-specific, ECG sign of acute right heart strain from PE.

Question 60: Which medication is the first-line treatment for a patient in symptomatic bradycardia with a pulse?

Amiodarone 300 mg IV
Adenosine 6 mg IV
Epinephrine 1 mg IV
Atropine 0.5 mg IV (Correct answer)

Correct answer: Atropine 0.5 mg IV

Atropine 0.5 mg IV is the first-line drug for symptomatic bradycardia, working by blocking vagal tone to increase heart rate.

Question 61: A 3-year-old child presents in respiratory arrest. Which BVM mask size and ventilation rate are most appropriate?

Infant mask, 30–40 breaths per minute
Pediatric mask, 20–30 breaths per minute (Correct answer)
Infant mask, 10–12 breaths per minute
Adult mask, 12–15 breaths per minute

Correct answer: Pediatric mask, 20–30 breaths per minute

A pediatric mask sized to fit the child's face is used, and the recommended ventilation rate for children in arrest is 20–30 breaths per minute.

Question 62: A paramedic needs to administer 250 mg of a drug supplied as 500 mg/10 mL. What volume should be administered?

7.5 mL
5 mL (Correct answer)
10 mL
2.5 mL

Correct answer: 5 mL

Using the formula: Volume = (Desired dose / Available dose) × Volume on hand = (250/500) × 10 = 5 mL.

Question 63: During an emergency response, the EMT is driving on a road with limited visibility in heavy rain. The best action is to:

Activate only the siren without warning lights to reduce distraction
Maintain normal highway speed to avoid backing up traffic
Increase speed to reduce time at risk on wet roads
Reduce speed and increase following distance (Correct answer)

Correct answer: Reduce speed and increase following distance

Wet conditions decrease stopping distance and visibility, requiring reduced speed and increased following distance.

Question 64: A patient in asystole undergoes CPR. Which medications are indicated per ACLS protocol? (Select the correct combination)

Atropine 1 mg + epinephrine 1 mg
Epinephrine 1 mg only (Correct answer)
Amiodarone 300 mg + epinephrine 1 mg
Vasopressin 40 units + lidocaine 1.5 mg/kg

Correct answer: Epinephrine 1 mg only

Current ACLS guidelines removed atropine from the asystole/PEA algorithm; only epinephrine 1 mg IV every 3–5 minutes is recommended.

Question 65: You are called to a 34-year-old female, G3P2 at 38 weeks gestation, whose membranes have just ruptured. During assessment, you visualize the umbilical cord protruding from the vagina. The patient is anxious and states she feels contractions. What is the most critical immediate intervention?

Encourage the patient to push forcefully with her next contraction to expedite delivery.
Attempt to gently push the cord back into the vaginal canal.
Place the patient in a knee-chest position and manually elevate the presenting fetal part. (Correct answer)
Administer high-flow oxygen and initiate rapid transport.

Correct answer: Place the patient in a knee-chest position and manually elevate the presenting fetal part.

Umbilical cord prolapse is a true obstetrical emergency where the cord is compressed between the presenting part and the maternal pelvis, cutting off oxygen to the fetus. The single most important intervention is to relieve this pressure. This is achieved by placing the mother in a knee-chest or exaggerated Sims' position and inserting a sterile gloved hand into the vagina to manually lift the presenting part off the cord. Pushing the cord back in is not recommended and can cause vasospasm. While oxygen and transport are necessary, they are not the first critical action to relieve the life-threatening compression.

Question 66: In thyroid storm, which of the following is the CORRECT order of medication administration?

Beta-blocker → steroids → PTU → iodine
PTU → beta-blocker → iodine → steroids (Correct answer)
Steroids → iodine → beta-blocker → PTU
Iodine → PTU → beta-blocker → steroids

Correct answer: PTU → beta-blocker → iodine → steroids

PTU must be given before iodine to block new thyroid hormone synthesis before iodine is administered, which would otherwise fuel more hormone production.

Question 67: A patient with an acute MI develops new-onset atrial fibrillation with rapid ventricular response at 140 bpm and is hemodynamically stable. Which is the BEST initial management?

Synchronized cardioversion at 200 J
Immediate unsynchronized defibrillation at 200 J
Adenosine 6 mg rapid IV push
Rate control with a beta-blocker or calcium channel blocker IV (Correct answer)

Correct answer: Rate control with a beta-blocker or calcium channel blocker IV

In stable AF with rapid ventricular response, the priority is rate control using IV beta-blockers (metoprolol) or non-dihydropyridine calcium channel blockers (diltiazem).

Question 68: In a patient with suspected pulmonary embolism, which triad of findings is classically described?

Fever, productive cough, decreased breath sounds
JVD, tracheal deviation, absent breath sounds
Chest pain, syncope, bradycardia
Hemoptysis, pleuritic chest pain, dyspnea (Correct answer)

Correct answer: Hemoptysis, pleuritic chest pain, dyspnea

The classic PE triad includes hemoptysis, pleuritic chest pain, and dyspnea, though all three are present in only a minority of cases.

Question 69: How many lumbar vertebrae are there in a human?

glucagon
brandykinesia, trembling, impaired balance, stiffness in the limbs
5 (Correct answer)
5ml

Correct answer: 5

The human lumbar spine has 5 vertebrae (L1-L5), located in the lower back. The other options are a hormone (glucagon), Parkinson's symptoms, and a volume measurement, none of which answer an anatomical count.

Question 70: A patient presents with sudden severe headache described as 'the worst of my life,' neck stiffness, and photophobia. What should the AEMCA suspect?

Hypertensive urgency
Migraine with aura
Subarachnoid hemorrhage (Correct answer)
Tension headache

Correct answer: Subarachnoid hemorrhage

A sudden 'thunderclap' headache with meningeal signs strongly suggests subarachnoid hemorrhage, a life-threatening emergency.

Question 71: An AEMCA who witnesses suspected elder abuse while on a call is legally:

Encouraged but not required to report the suspicion
Prohibited from reporting without patient consent
Required to report the suspicion to the appropriate authorities (Correct answer)
Only required to report confirmed cases, not suspicions

Correct answer: Required to report the suspicion to the appropriate authorities

EMS providers are mandated reporters in most jurisdictions and are legally required to report suspected elder abuse to protective services or law enforcement.

Question 72: A 4-year-old is found unresponsive after suspected submersion. After 5 initial rescue breaths, you find no pulse. What is the correct CPR compression-to-ventilation ratio for a two-rescuer pediatric resuscitation?

30:1
30:2
15:1
15:2 (Correct answer)

Correct answer: 15:2

Two-rescuer pediatric CPR uses a 15:2 compression-to-ventilation ratio, optimizing coronary perfusion pressure while accounting for the often respiratory-cause of pediatric arrest.

Question 73: During orotracheal intubation, the AEMCA visualizes the vocal cords and inserts the ETT. What is the next immediate action?

Attach the BVM and begin ventilations
Secure the tube with tape
Obtain a waveform capnography reading
Inflate the cuff and confirm placement (Correct answer)

Correct answer: Inflate the cuff and confirm placement

After tube insertion, the cuff must be inflated immediately to create a seal, then placement is confirmed before ventilations continue.

Question 74: Which IV fluid is most appropriate for a patient in severe diabetic ketoacidosis presenting with hypotension?

Lactated Ringer's
0.45% NaCl (half-normal saline)
D5W (5% dextrose in water)
0.9% NaCl (normal saline) (Correct answer)

Correct answer: 0.9% NaCl (normal saline)

Normal saline is the initial resuscitation fluid of choice in DKA to restore intravascular volume before transitioning to hypotonic fluids.

Question 75: Which of the following scenarios most clearly represents a conflict between patient autonomy and beneficence?

A provider treats an unconscious patient without consent
A competent patient refuses a blood transfusion that could save their life (Correct answer)
An AEMCA chooses between two equally effective treatments
A provider reports suspected child abuse to authorities

Correct answer: A competent patient refuses a blood transfusion that could save their life

This scenario pits the patient's right to refuse care (autonomy) against the provider's obligation to act in the patient's best interest (beneficence).

Question 76: Which presentation is MOST consistent with a patient experiencing neurogenic shock?

Hypotension, tachycardia, poor skin turgor
Hypertension, bradycardia, diaphoresis
Hypotension, bradycardia, warm dry skin (Correct answer)
Hypertension, tachycardia, cold clammy skin

Correct answer: Hypotension, bradycardia, warm dry skin

Neurogenic shock from spinal cord injury presents with hypotension and paradoxical bradycardia with warm, dry skin due to loss of sympathetic tone below the injury.

Question 77: Which fluid resuscitation strategy is currently recommended for hemorrhagic shock in penetrating trauma to prevent worsening coagulopathy?

Colloid-only resuscitation
Permissive hypotension with limited crystalloid (Correct answer)
No IV fluids until surgical hemorrhage control
Aggressive 2-liter crystalloid bolus

Correct answer: Permissive hypotension with limited crystalloid

Permissive hypotension (targeting SBP ~80–90 mmHg) with limited crystalloid minimizes dilutional coagulopathy and clot disruption until surgical control.

Question 78: Activated charcoal is MOST effective when given within which time frame after ingestion?

Within 6 hours
Within 1 hour (Correct answer)
Within 4 hours
Within 2 hours

Correct answer: Within 1 hour

Activated charcoal is most effective within 1 hour of ingestion before significant drug absorption has occurred.

Question 79: Which medication is contraindicated in patients with suspected cocaine-induced chest pain and hypertension?

Nitroglycerin
Propranolol (Correct answer)
Aspirin
Lorazepam

Correct answer: Propranolol

Non-selective beta-blockers like propranolol cause unopposed alpha-adrenergic stimulation, worsening coronary vasospasm in cocaine toxicity.

Question 80: A patient presents with a BP of 210/120 mmHg, severe headache, and blurred vision. This is classified as a hypertensive:

Response requiring oral antihypertensives only
Emergency with end-organ damage (Correct answer)
Urgency with no end-organ damage
Crisis requiring immediate defibrillation

Correct answer: Emergency with end-organ damage

Hypertensive emergency is defined by severely elevated BP with acute end-organ damage (neurological symptoms here), requiring IV antihypertensive therapy.

Question 81: Which of the following is a normal respiratory rate for a 1-year-old child at rest?

60–80 breaths per minute
20–30 breaths per minute
25–50 breaths per minute (Correct answer)
12–20 breaths per minute

Correct answer: 25–50 breaths per minute

Normal resting respiratory rate for a 1-year-old is approximately 25–50 breaths per minute; rates vary by age and decrease as children grow.

Question 82: During a field delivery, the baby's head delivers but the shoulders do not follow with the next contraction. Your first maneuver should be:

Apply suprapubic pressure while guiding the head downward (Correct answer)
Perform an episiotomy
Apply fundal pressure
Attempt to rotate the infant 180 degrees

Correct answer: Apply suprapubic pressure while guiding the head downward

Shoulder dystocia is managed first with suprapubic pressure (not fundal) combined with downward traction on the fetal head to dislodge the anterior shoulder.

Question 83: In the prehospital setting, what is the primary goal of hyperventilation in a head-injured patient with signs of herniation?

Improve oxygenation
Increase cerebral blood flow
Correct metabolic acidosis
Temporarily reduce intracranial pressure by inducing vasoconstriction (Correct answer)

Correct answer: Temporarily reduce intracranial pressure by inducing vasoconstriction

Controlled mild hyperventilation lowers PaCO2, causing cerebral vasoconstriction and a temporary reduction in intracranial pressure.

Question 84: A patient with a known peanut allergy develops urticaria, angioedema, and stridor within minutes of eating. After administering IM epinephrine, the patient does not improve. What is the next action?

Switch to IV diphenhydramine as epinephrine failed
Administer IV corticosteroids and observe for 30 minutes
Perform immediate needle decompression
Administer a second dose of IM epinephrine and prepare for airway management (Correct answer)

Correct answer: Administer a second dose of IM epinephrine and prepare for airway management

A second dose of epinephrine can be given 5-15 minutes after the first if the patient does not respond; progressive stridor also demands preparation for surgical airway.

Question 85: You are assessing a patient with suspected Acute Coronary Syndrome. Which of the following 12-lead ECG findings is most indicative of a STEMI (ST-Segment Elevation Myocardial Infarction) requiring immediate reperfusion therapy?

Presence of a pathological Q-wave
ST-segment depression in leads V1-V4
Peaked T-waves in precordial leads
ST-segment elevation of 2 mm or more in two contiguous leads (Correct answer)

Correct answer: ST-segment elevation of 2 mm or more in two contiguous leads

The diagnostic criteria for a STEMI on a 12-lead ECG is significant ST-segment elevation in two or more anatomically contiguous leads. This finding indicates a full-thickness myocardial injury and is a critical indicator for activating cardiac catheterization lab protocols for reperfusion.

Question 86: You are called for a 2-year-old who had a generalized tonic-clonic seizure. Upon arrival, the seizure has stopped, and the child is postictal but rousable. The parents state the seizure lasted about 3 minutes and the child has a fever of 39.5°C. What is the most appropriate next action?

Perform a blood glucose check and provide supportive care, including cooling measures.
Establish IV access and administer an antipyretic immediately.
Immediately transport without further assessment to rule out meningitis. (Correct answer)
Administer a prophylactic dose of midazolam to prevent another seizure.

Correct answer: Immediately transport without further assessment to rule out meningitis.

This presentation is consistent with a simple febrile seizure, which is typically benign and self-limiting. The priority after the seizure has ceased is supportive care. This includes assessing the patient (including a blood glucose check, as hypoglycemia can cause seizures), ensuring a patent airway, and initiating passive cooling measures for the fever. Prophylactic benzodiazepines are not indicated for a seizure that has already terminated.

Question 87: What is the correct intraosseous (IO) needle placement site for a 2-year-old in cardiac arrest when IV access cannot be obtained?

Iliac crest, posterior superior spine
Humeral head, greater tubercle
Distal femur, 3 cm above the lateral condyle
Proximal tibia, 1–2 cm below the tibial tuberosity on the anteromedial surface (Correct answer)

Correct answer: Proximal tibia, 1–2 cm below the tibial tuberosity on the anteromedial surface

The proximal tibia (1–2 cm below the tibial tuberosity on the anteromedial flat surface) is the preferred first-line IO site in pediatric patients.

Question 88: A patient has gurgling respirations after a seizure. What is the FIRST intervention?

Insert an oropharyngeal airway
Suction the airway (Correct answer)
Begin BVM ventilations
Perform a jaw-thrust

Correct answer: Suction the airway

Gurgling indicates secretions or fluid in the upper airway; suctioning must occur immediately to clear the obstruction before other interventions.

Question 89: You are managing a 30-year-old patient who is experiencing a prolonged generalized tonic-clonic seizure lasting more than 5 minutes. Which of the following is the first-line medication and preferred route of administration for status epilepticus according to AEMCA protocols, especially when IV access is delayed?

Lorazepam, IV
Midazolam, IM (Correct answer)
Phenytoin, IV infusion
Diazepam, Rectal

Correct answer: Midazolam, IM

For status epilepticus in the prehospital setting, especially when IV access is not yet established or is difficult to obtain during a seizure, Midazolam administered intramuscularly (IM) is the preferred first-line benzodiazepine due to its rapid absorption and ease of administration.

Question 90: Which of the following is considered the most reliable method for confirming initial and ongoing placement of an endotracheal tube in a patient with a perfusing rhythm?

Continuous waveform capnography (Correct answer)
Bilateral breath sounds on auscultation
Use of an esophageal detector device (EDD)
Condensation in the endotracheal tube

Correct answer: Continuous waveform capnography

Continuous waveform capnography is the gold standard for confirming and monitoring endotracheal tube placement. It provides real-time, breath-to-breath analysis of expired CO2, which is the most reliable indicator that the tube is in the trachea and not the esophagus. Other methods like auscultation, chest rise, and EDD are useful secondary confirmation techniques but are not as definitive.

Question 91: A patient at 31 weeks has a gush of clear fluid from the vagina without contractions. Your HIGHEST priority assessment concern is:

Administer oxygen and obtain IV access
Determine whether she had intercourse in the last 24 hours
Check fundal height to estimate gestational age
Inspect for cord prolapse before providing any treatment (Correct answer)

Correct answer: Inspect for cord prolapse before providing any treatment

Premature rupture of membranes with fluid gush requires immediate inspection for umbilical cord prolapse, which is a life-threatening emergency.

Question 92: What is the most common shockable cardiac rhythm encountered in pediatric cardiac arrest?

Pulseless electrical activity (PEA)
Asystole (Correct answer)
Ventricular fibrillation (VF)
Pulseless ventricular tachycardia (VT)

Correct answer: Asystole

Unlike adults, pediatric cardiac arrest is most commonly caused by respiratory failure or shock, resulting in asystole or PEA as the predominant initial rhythms rather than shockable rhythms.

Question 93: Which of the following techniques is most critical for preventing personal injury, particularly to the back, when lifting a heavy patient on a stretcher?

Bending at the waist while keeping the legs straight to maximize reach.
Using a quick, jerking motion to take advantage of momentum.
Positioning your feet close together to create a narrow base of support.
Keeping your back straight, tightening your core muscles, and lifting with your leg muscles. (Correct answer)

Correct answer: Keeping your back straight, tightening your core muscles, and lifting with your leg muscles.

Proper body mechanics are essential to prevent musculoskeletal injuries in EMS. The correct technique involves keeping the back straight in a locked-in position, getting close to the patient, establishing a wide base of support, and using the large muscles of the legs and hips to generate lifting power, not the back muscles.

Question 94: A 25-year-old male was stabbed in the left chest. He is in severe respiratory distress with absent breath sounds on the left. After sealing the wound, his condition worsens. What should you do?

Briefly lift or 'burp' the dressing to release trapped air (Correct answer)
Perform needle decompression on the right side
Apply a second occlusive dressing over the first
Initiate CPR immediately

Correct answer: Briefly lift or 'burp' the dressing to release trapped air

If an occlusive chest seal causes worsening, it may be trapping air; briefly lifting (burping) the dressing allows pressure to escape and can relieve tension pneumothorax.

Question 95: A patient with sickle cell disease presents with chest pain, fever, and progressive hypoxia. What is the most likely life-threatening complication?

Splenic sequestration
Aplastic crisis
Vaso-occlusive pain crisis only
Acute chest syndrome (Correct answer)

Correct answer: Acute chest syndrome

Acute chest syndrome is a leading cause of death in sickle cell disease, characterized by new pulmonary infiltrates with fever, chest pain, and hypoxia.

Question 96: A patient's blood pressure is 220/120 mmHg after an ischemic stroke. In the prehospital setting, what is the correct approach?

Give sublingual nitroglycerin
Do not treat unless BP exceeds 220/120 or patient is symptomatic beyond stroke (Correct answer)
Aggressively lower BP to below 140 systolic
Administer labetalol 20 mg IV immediately

Correct answer: Do not treat unless BP exceeds 220/120 or patient is symptomatic beyond stroke

In ischemic stroke, permissive hypertension maintains cerebral perfusion; prehospital providers should generally avoid lowering BP unless directed by medical control.

Question 97: When using a bag-valve-mask device on an adult patient, what tidal volume should you target to avoid gastric insufflation?

300 mL delivered over 0.5 seconds
800–1000 mL delivered rapidly
500–600 mL delivered over 1 second (Correct answer)
1200 mL delivered over 2 seconds

Correct answer: 500–600 mL delivered over 1 second

A tidal volume of 500–600 mL over about 1 second is sufficient for oxygenation and minimizes the risk of gastric insufflation and aspiration.

Question 98: Which type of shock is most commonly associated with a cervical spinal cord injury at C5?

Neurogenic shock (Correct answer)
Hypovolemic shock
Obstructive shock
Septic shock

Correct answer: Neurogenic shock

High cervical cord injuries disrupt sympathetic tone, causing vasodilation and bradycardia — the hallmarks of neurogenic shock.

Question 99: An 18-month-old child involved in a traumatic incident is showing signs of compensated shock, including tachycardia, cool extremities, and a capillary refill time of 4 seconds. According to pediatric resuscitation guidelines, what is the correct initial fluid bolus?

20 mL/kg of an isotonic crystalloid over 5-20 minutes. (Correct answer)
40 mL/kg of 0.45% saline over one hour.
5 mL/kg of a colloid solution over 30 minutes.
10 mL/kg of D5W as rapidly as possible.

Correct answer: 20 mL/kg of an isotonic crystalloid over 5-20 minutes.

For pediatric patients in shock (hypovolemic or septic, without cardiogenic cause), the standard initial intervention is a rapid fluid bolus of 20 mL/kg of an isotonic crystalloid solution, such as Normal Saline or Ringer's Lactate. This bolus should be administered quickly, typically over 5 to 20 minutes, followed by reassessment of the patient's perfusion status.

Question 100: During a mass casualty incident, which triage tag color indicates a patient who is deceased or has injuries incompatible with survival?

Black (Correct answer)
Red
Yellow
Green

Correct answer: Black

Black tags are assigned to patients who are deceased or have injuries so severe that survival is not expected even with medical intervention.

Question 101: Which ICS position is responsible for the overall management of an incident and all incident objectives?

Safety Officer
Incident Commander (Correct answer)
Logistics Section Chief
Operations Section Chief

Correct answer: Incident Commander

The Incident Commander holds overall responsibility for managing the incident and setting all strategic objectives.

Question 102: When a patient has ingested a caustic substance (strong acid or base), which prehospital intervention is contraindicated?

High-flow supplemental oxygen
Supportive airway management
IV fluid administration for hemodynamic support
Inducing vomiting or gastric lavage (Correct answer)

Correct answer: Inducing vomiting or gastric lavage

Inducing vomiting after caustic ingestion is contraindicated because it re-exposes the esophagus, oropharynx, and airway to the caustic substance, worsening mucosal injury.

Question 103: A patient with a crush injury to the lower extremities is extricated after 4 hours. You should be most concerned about which life-threatening complication upon release?

Disseminated intravascular coagulation immediately
Pulmonary embolism from fat emboli
Hyperkalemia and acute renal failure from rhabdomyolysis (Correct answer)
Tension pneumothorax from chest compression

Correct answer: Hyperkalemia and acute renal failure from rhabdomyolysis

Crush syndrome releases myoglobin and potassium from damaged muscle into circulation, causing hyperkalemia and tubular obstruction leading to renal failure.

Question 104: You are treating a 25-year-old who fell from a significant height and is complaining of paralysis below the waist. His blood pressure is 80/50 mmHg, heart rate is 58 bpm, and his skin below the chest is warm and dry. Which type of shock is most consistent with this presentation?

Neurogenic Shock (Correct answer)
Hypovolemic Shock
Cardiogenic Shock
Septic Shock

Correct answer: Neurogenic Shock

This patient's presentation is classic for neurogenic shock, a form of distributive shock. The spinal cord injury disrupts sympathetic nervous system signals, leading to widespread vasodilation and a loss of sympathetic tone to the heart. This results in hypotension combined with a normal or slow heart rate (bradycardia) and warm, dry skin below the level of the injury, contrasting with the cool, clammy skin seen in hypovolemic shock.

Question 105: A patient with COPD is found with a decreased level of consciousness and a SpO2 of 72%. The AEMCA should:

Withhold oxygen to avoid suppressing the hypoxic drive
Observe the patient without oxygen until SpO2 falls below 60%
Apply high-flow oxygen and be prepared to assist ventilations (Correct answer)
Use a Venturi mask set at 24% FiO2 only

Correct answer: Apply high-flow oxygen and be prepared to assist ventilations

Severe hypoxia (SpO2 72%) is immediately life-threatening; high-flow oxygen and ventilatory support take priority over concern about hypoxic drive.

Question 106: Which sign is most specific for right-sided heart failure in a medical emergency assessment?

Pulmonary edema with crackles
Orthopnea
Pink frothy sputum
Jugular venous distension (Correct answer)

Correct answer: Jugular venous distension

Jugular venous distension (JVD) reflects elevated central venous pressure and is most specific for right-sided heart failure.

Question 107: During suction of an intubated patient, how long should each suction pass last?

Up to 30 seconds
No more than 10–15 seconds (Correct answer)
5 seconds maximum
As long as needed to clear secretions

Correct answer: No more than 10–15 seconds

Suction passes should be limited to 10–15 seconds to prevent hypoxia and atelectasis from removing oxygen along with secretions.

Question 108: An AEMCA documents in the patient care report that a patient was 'intoxicated and uncooperative' without objective clinical findings. This documentation could create liability for:

Battery
Negligence
Defamation (Correct answer)
False imprisonment

Correct answer: Defamation

Documenting subjective characterizations without clinical basis can constitute defamation if the statements damage the patient's reputation.

Question 109: Which electrolyte abnormality is most associated with peaked T-waves and widened QRS complex on ECG?

Hyperkalemia (Correct answer)
Hypomagnesemia
Hypercalcemia
Hyponatremia

Correct answer: Hyperkalemia

Hyperkalemia causes progressive ECG changes including peaked T-waves, prolonged PR interval, widened QRS, and ultimately a sine-wave pattern.

Question 110: What does the acronym 'OPQRST' stand for in EMS patient assessment?

Origin, Provocation, Quantity, Region, Symptoms, Type
Onset, Position, Quality, Radiation, Symptoms, Timing
Origin, Pain, Quality, Response, Severity, Treatment
Onset, Provocation, Quality, Region/Radiation, Severity, Time (Correct answer)

Correct answer: Onset, Provocation, Quality, Region/Radiation, Severity, Time

OPQRST (Onset, Provocation, Quality, Region/Radiation, Severity, Time) is the standard mnemonic for characterizing a patient's chief complaint.

Question 111: Which landmark is used to confirm proper endotracheal tube depth in an average adult male?

Tube tip at 18 cm at the teeth
22 cm mark at the lip for males (Correct answer)
25 cm mark at the lips for all adults
Cuff should be at vocal cord level

Correct answer: 22 cm mark at the lip for males

For average adult males, the ETT is positioned at approximately 22–23 cm at the lip to place the tube tip mid-trachea.

Question 112: A 70 kg patient in cardiogenic shock requires a dopamine infusion at 5 mcg/kg/min. You have dopamine 400 mg in 250 mL NS. What is the infusion rate in mL/hr?

21.0 mL/hr
13.1 mL/hr (Correct answer)
26.3 mL/hr
10.5 mL/hr

Correct answer: 13.1 mL/hr

Concentration = 400 mg/250 mL = 1600 mcg/mL; dose = 5 mcg/kg/min × 70 kg = 350 mcg/min = 21,000 mcg/hr; rate = 21,000/1600 ≈ 13.1 mL/hr.

Question 113: A cyclist struck by a car has a closed femur fracture. Approximately how much blood can be lost into the thigh from this injury?

Up to 1,500 mL (Correct answer)
Up to 300 mL
Up to 500 mL
Up to 3,000 mL

Correct answer: Up to 1,500 mL

A closed femur fracture can conceal up to 1,000–1,500 mL of blood within the thigh compartment, contributing significantly to hypovolemic shock.

Question 114: Which of the following is a contraindication to the use of succinylcholine during RSI?

Systolic blood pressure below 90 mmHg
Increased intracranial pressure
Rapid sequence intubation in less than 8 hours post-injury
Burns more than 48–72 hours old or crush injuries with suspected hyperkalemia (Correct answer)

Correct answer: Burns more than 48–72 hours old or crush injuries with suspected hyperkalemia

Succinylcholine is contraindicated in burns >48–72 hours old, crush injuries, and denervation injuries because up-regulated acetylcholine receptors can cause fatal hyperkalemia.

Question 115: A patient has Beck's triad following blunt chest trauma. Which emergency procedure does this finding indicate?

Pericardiocentesis for cardiac tamponade (Correct answer)
Chest tube insertion for hemothorax
Endotracheal intubation for airway protection
Needle decompression for tension pneumothorax

Correct answer: Pericardiocentesis for cardiac tamponade

Beck's triad (hypotension, muffled heart sounds, JVD) indicates cardiac tamponade, which requires pericardiocentesis to relieve pericardial pressure.

Question 116: A patient presents with one-sided weakness, facial droop, and slurred speech that resolved completely within 30 minutes. What is this event called?

Transient ischemic attack (TIA) (Correct answer)
Todd's paralysis
Completed stroke
Hemiplegic migraine

Correct answer: Transient ischemic attack (TIA)

A TIA involves focal neurological deficits that resolve within 24 hours (often minutes) and is a major warning sign of imminent stroke.

Question 117: A patient with a valid Do Not Resuscitate (DNR) order goes into cardiac arrest. What is the AEMCA's appropriate action?

Contact medical direction before making any decision
Initiate CPR regardless of the DNR
Attempt resuscitation until family members arrive
Honor the DNR and withhold resuscitation (Correct answer)

Correct answer: Honor the DNR and withhold resuscitation

A valid DNR order is a legal document that must be honored; withholding resuscitation respects the patient's documented wishes.

Question 118: A 40-year-old male has sustained a stab wound to the abdomen. He is conscious and alert, with a radial pulse present, a heart rate of 110 bpm, and a blood pressure of 94/70 mmHg. There is no evidence of a head injury. What is the most appropriate fluid resuscitation strategy for this patient?

Administer a 20 mL/kg bolus of normal saline as quickly as possible.
Withhold all IV fluids to prevent any potential clot disruption.
Administer fluid boluses aggressively to achieve a systolic blood pressure of at least 120 mmHg.
Administer small, titrated fluid boluses to maintain a palpable radial pulse. (Correct answer)

Correct answer: Administer small, titrated fluid boluses to maintain a palpable radial pulse.

This patient is a candidate for permissive hypotension. In penetrating torso trauma without a head injury, the goal is to provide enough fluid to maintain perfusion to vital organs (indicated by a palpable radial pulse, which correlates to a systolic BP of approximately 80-90 mmHg) without raising the blood pressure so high that it dislodges any clots that have formed ('popping the clot') and worsens internal hemorrhage. Aggressive resuscitation to a normal BP is contraindicated until the bleeding is surgically controlled.

Question 119: Which clinical sign BEST indicates that a patient's airway is partially obstructed by the tongue?

Absent breath sounds bilaterally
Snoring respirations (Correct answer)
Cyanosis of the lips
Paradoxical chest movement

Correct answer: Snoring respirations

Snoring respirations occur when the relaxed tongue partially occludes the posterior pharynx, a classic sign of soft-tissue upper airway obstruction.

Question 120: A patient presents with a suspected opioid overdose: unresponsive, pinpoint pupils, respiratory rate of 4/min. What is the correct naloxone dose for an adult?

2 mg IV once only
10 mg IV push
0.1 mg/kg IV every 5 minutes
0.4–2 mg IV/IM/IN, titrated to restore adequate breathing (Correct answer)

Correct answer: 0.4–2 mg IV/IM/IN, titrated to restore adequate breathing

Naloxone is titrated at 0.4–2 mg IV/IM/IN to restore spontaneous respirations without precipitating acute withdrawal; repeat as needed based on response.

Question 121: Which finding differentiates hypertensive emergency from hypertensive urgency?

Symptomatic complaints such as headache
Patient's age and comorbidities
Presence of end-organ damage (Correct answer)
Blood pressure greater than 180/120 mmHg

Correct answer: Presence of end-organ damage

Hypertensive emergency is defined by evidence of acute end-organ damage (stroke, MI, renal failure, retinopathy) regardless of the exact blood pressure value.

Question 122: Which route of administration provides the most rapid onset of medication action in a prehospital emergency?

Intravenous (Correct answer)
Intranasal
Sublingual
Intramuscular

Correct answer: Intravenous

IV administration delivers medication directly into systemic circulation, providing the fastest onset compared to all other routes.

Question 123: When applying a 12-lead ECG, which limb lead placement error will invert Lead I and reverse aVR and aVL?

Swapping LA and LL electrodes
Swapping LL and RL electrodes
Swapping RA and RL electrodes
Swapping RA and LA electrodes (Correct answer)

Correct answer: Swapping RA and LA electrodes

Swapping the right arm (RA) and left arm (LA) electrodes inverts Lead I and reverses the augmented limb leads aVR and aVL.

Question 124: Which reversible cause of PEA is suggested by distended neck veins, absent breath sounds on the left, and tracheal deviation to the right?

Pulmonary embolism
Hypovolemia
Cardiac tamponade
Tension pneumothorax (Correct answer)

Correct answer: Tension pneumothorax

Tension pneumothorax causes JVD, absent breath sounds on the affected side, and tracheal deviation away from the affected side, and is a reversible cause of PEA.

Question 125: Which medication used in rapid sequence intubation causes increased intracranial pressure as a side effect?

Rocuronium
Etomidate
Ketamine (Correct answer)
Succinylcholine

Correct answer: Ketamine

Ketamine was historically avoided in head injury due to concern for ICP elevation, though this is now debated; it remains a consideration in RSI planning.

Question 126: A 68-year-old male presents with sudden onset of severe tearing chest pain that radiates to his back. He has a history of uncontrolled hypertension. His vital signs are BP 210/110 mmHg, HR 110 bpm, and RR 22 breaths/min. There is a noticeable difference in blood pressure between his right and left arms. Which of the following conditions is most likely?

Aortic Dissection (Correct answer)
Pericarditis
Acute Myocardial Infarction
Pulmonary Embolism

Correct answer: Aortic Dissection

The classic presentation of an aortic dissection includes a sudden onset of severe, tearing or ripping chest pain that often radiates to the back, between the shoulder blades. A significant finding is a variation in blood pressure between the arms. The patient's history of uncontrolled hypertension is a major risk factor.

Question 127: A patient in ventricular fibrillation receives a defibrillation shock. What is the IMMEDIATE next step after the shock is delivered?

Resume CPR for 2 minutes (Correct answer)
Check the pulse
Administer 1 mg epinephrine IV
Deliver a second shock at higher energy

Correct answer: Resume CPR for 2 minutes

Current AHA guidelines require immediate resumption of CPR for 2 minutes after a defibrillation shock before rhythm and pulse checks.

Question 128: When is it legally permissible for an AEMCA to disclose patient information to law enforcement without patient consent?

Whenever an officer requests it on scene
When required by mandatory reporting laws such as for gunshot wounds (Correct answer)
When the patient is a minor
Any time the patient is unconscious

Correct answer: When required by mandatory reporting laws such as for gunshot wounds

Mandatory reporting laws legally require disclosure of specific information such as gunshot wounds, stab wounds, and suspected abuse to law enforcement.

Question 129: When performing needle decompression for suspected tension pneumothorax, which landmark is the preferred insertion site?

2nd intercostal space, midclavicular line (Correct answer)
3rd intercostal space, midsternal line
4th intercostal space, midaxillary line
5th intercostal space, anterior axillary line

Correct answer: 2nd intercostal space, midclavicular line

The 2nd intercostal space at the midclavicular line is the standard landmark for needle decompression to avoid neurovascular bundles and major vessels.

Question 130: Beck's triad, a collection of signs associated with acute cardiac tamponade, consists of which of the following?

Paradoxical chest movement, dyspnea, and localized pain.
Hypotension, jugular venous distention, and muffled heart sounds. (Correct answer)
Unilateral chest rise, tracheal deviation, and subcutaneous emphysema.
Hypertension, bradycardia, and irregular respirations.

Correct answer: Hypotension, jugular venous distention, and muffled heart sounds.

Beck's triad is the classic set of signs for cardiac tamponade. It includes: 1) Hypotension due to decreased cardiac output from the compressed heart, 2) Jugular venous distention (JVD) from blood backing up into the venous system, and 3) Muffled heart sounds due to the insulating effect of the fluid in the pericardial sac. The other answer choices describe Cushing's triad (head injury), signs of a tension pneumothorax, and signs of a flail chest, respectively.

Question 131: Which neurotransmitter is in charge of sympathetic nervous system activity?

salbutamol and terbutaline
endorphins and enkephalins
afferent and efferent
epinephrine and norepiephrine (Correct answer)

Correct answer: epinephrine and norepiephrine

Epinephrine and norepinephrine are the catecholamines that drive sympathetic ('fight or flight') activity, released by postganglionic sympathetic neurons (norepinephrine) and the adrenal medulla (both). The other options list nerve fiber types, endogenous opioids, and beta-agonist drugs, none of which are the primary sympathetic neurotransmitters.

Question 132: You are treating a patient in anaphylactic shock with severe bronchospasm and hypotension. After epinephrine 0.3 mg IM, the patient remains hemodynamically unstable. What is the next appropriate intervention?

Apply CPAP for respiratory support only
Administer diphenhydramine IV as first-line rescue
Administer albuterol nebulizer and observe
Repeat epinephrine IM and establish IV access for fluid bolus (Correct answer)

Correct answer: Repeat epinephrine IM and establish IV access for fluid bolus

If initial epinephrine IM fails, a repeat dose should be given while establishing IV access for fluid resuscitation to counter vasodilation.

Question 133: Which of the following constellations of findings is most indicative of a patient meeting prehospital sepsis criteria, warranting a 'sepsis alert' notification to the receiving hospital?

Productive cough, heart rate of 95 bpm, and a blood pressure of 130/80 mmHg.
Localized cellulitis, normal mental status, and a heart rate of 88 bpm.
Suspected infection, fever of 38.5°C, and a new onset of confusion. (Correct answer)
History of a UTI, respiratory rate of 18, and warm, dry skin.

Correct answer: Suspected infection, fever of 38.5°C, and a new onset of confusion.

Prehospital sepsis screening tools (like qSOFA or SIRS) look for a suspected source of infection plus signs of systemic response or organ dysfunction. The combination of a suspected infection, fever (temperature >38°C), and altered mental status (new confusion) strongly suggests sepsis with organ dysfunction, meeting the criteria for a sepsis alert.

Question 134: At what blood glucose level is hypoglycemia generally defined in adults?

< 80 mg/dL
< 100 mg/dL
< 70 mg/dL (Correct answer)
< 60 mg/dL

Correct answer: < 70 mg/dL

Hypoglycemia is defined as blood glucose below 70 mg/dL, at which point most patients begin to experience symptoms.

Question 135: A HAZMAT placard showing a skull and crossbones indicates:

Toxic or poisonous material (Correct answer)
Oxidizing agent
Radioactive material
Flammable material

Correct answer: Toxic or poisonous material

The skull and crossbones symbol (DOT Class 6) indicates toxic or poisonous materials that pose a serious health hazard.

Question 136: A patient with hypovolemic shock has received 2 liters of normal saline but remains hypotensive. What complication of large-volume crystalloid resuscitation should you anticipate?

Hyperkalemia from cellular lysis
Dilutional coagulopathy and hypothermia (Correct answer)
Acute hypernatremia
Metabolic alkalosis

Correct answer: Dilutional coagulopathy and hypothermia

Large volumes of crystalloid dilute clotting factors and cool the patient, contributing to the lethal triad of coagulopathy and hypothermia.

Question 137: How does cor pulmonale develop in a patient with chronic bronchitis?

Low V/Q mismatch - decrease in ventilation compared to profusion due to the body trying to compensate by increasing the heart rate and decreasing ventilation
The disease leads to chronic high CO2 levels in the blood which trigger pulmonary vasoconstriction which puts extra pressure on the right side of the heart to work (Correct answer)
a) under police authority b) under Dr. authority c) pt in ambulance becomes violent en route
The peritubular capillaries reabsorb minerals from the renal tubule such as glucose, ions, water, amino acids

Correct answer: The disease leads to chronic high CO2 levels in the blood which trigger pulmonary vasoconstriction which puts extra pressure on the right side of the heart to work

In chronic bronchitis, impaired gas exchange causes chronic hypercapnia (high CO2) and hypoxia, which trigger pulmonary vasoconstriction. This raises pulmonary arterial pressure, forcing the right ventricle to work harder and eventually leading to right-sided heart failure (cor pulmonale). The other options describe tubular reabsorption, V/Q mismatch, and exemptions from medical directives.

Question 138: You are called to a 24-year-old found unresponsive in a public washroom. The patient has a respiratory rate of 4 breaths per minute, pinpoint pupils, and central cyanosis. What is the most important initial intervention after ensuring the airway is open?

Administer Naloxone via the intranasal or intramuscular route. (Correct answer)
Perform a 12-lead ECG to rule out a cardiac cause.
Establish IV access for fluid resuscitation.
Apply high-flow oxygen via a non-rebreather mask.

Correct answer: Administer Naloxone via the intranasal or intramuscular route.

The clinical presentation is classic for an opioid overdose causing severe respiratory depression. The most critical and definitive initial intervention is to reverse the effects of the opioids by administering Naloxone. While airway and ventilation support are crucial and should be done concurrently, Naloxone is the specific antidote that addresses the root cause of respiratory failure.

Question 139: Which of the following is an example of expressed consent?

A bystander authorizing care for an unresponsive stranger
A patient nodding and rolling up their sleeve for an IV (Correct answer)
An unconscious patient receiving an IV during resuscitation
A minor treated under parental authority

Correct answer: A patient nodding and rolling up their sleeve for an IV

Expressed consent can be verbal or non-verbal (such as a gesture); a patient nodding and exposing their arm clearly communicates agreement to treatment.

Question 140: A 65-year-old patient presents with sudden onset of unilateral facial droop, arm weakness, and slurred speech that began 45 minutes ago. The MOST critical action is:

Transport immediately to a stroke center (Correct answer)
Administer aspirin 324mg immediately
Perform a full neurological assessment before transport
Establish IV access and administer fluid bolus

Correct answer: Transport immediately to a stroke center

Time is brain — immediate transport to a stroke center maximizes the window for thrombolytic therapy or mechanical thrombectomy.

Question 141: Which of the following best describes the purpose of the scene size-up in patient assessment?

Perform a head-to-toe physical examination
Identify hazards, determine mechanism of injury, and estimate number of patients (Correct answer)
Administer initial treatment for life threats
Obtain the patient's medical history

Correct answer: Identify hazards, determine mechanism of injury, and estimate number of patients

The scene size-up establishes scene safety, identifies the mechanism of injury or nature of illness, and determines how many patients require care.

Question 142: Which ECG finding is most characteristic of hyperkalemia-induced cardiac toxicity?

Prolonged QT interval
Peaked (tall, narrow) T waves (Correct answer)
Prominent U waves
ST-segment depression in V4-V6

Correct answer: Peaked (tall, narrow) T waves

Hyperkalemia classically causes tall, peaked, narrow T waves as an early sign of cardiac toxicity.

Question 143: During a field delivery, the amniotic sac has not ruptured and the infant delivers inside the intact membranes ('en caul'). You should:

Puncture and peel away the membranes from the infant's face immediately (Correct answer)
Administer oxygen to the mother to improve fetal oxygenation through the intact sac
Leave the membranes intact and transport to allow hospital delivery
Clamp and cut the membranes as you would the umbilical cord

Correct answer: Puncture and peel away the membranes from the infant's face immediately

An en caul delivery requires the provider to immediately puncture and remove the membranes from the infant's face to allow breathing.

Question 144: A 70 kg adult patient is in status epilepticus. The paramedic decides to administer midazolam via the IM route. The protocol calls for a dose of 10 mg. Your vial concentration is 5 mg/mL. How many milliliters should be administered?

0.5 mL
1.5 mL
1.0 mL
2.0 mL (Correct answer)

Correct answer: 2.0 mL

This is a drug calculation question. The formula is: (Dose Required / Concentration on Hand) = Volume to Administer. In this case, (10 mg / 5 mg/mL) = 2.0 mL. The paramedic should administer 2.0 mL of midazolam. The adult dose for status epilepticus is commonly a standard 10 mg IM for patients over a certain weight threshold, making this a typical prehospital scenario.

Question 145: During an MCI, the SALT triage method's first step is to:

Sort patients by asking ambulatory patients to move to a designated area (Correct answer)
Immediately treat life-threatening hemorrhage in all patients
Assess all patients individually beginning with the closest
Tag all unconscious patients as expectant

Correct answer: Sort patients by asking ambulatory patients to move to a designated area

SALT begins by globally sorting patients — those who can walk are directed to a designated area, quickly identifying lower-priority patients.

Question 146: An 80-year-old female is found unconscious with a blood glucose level of 1.8 mmol/L. IV access is unsuccessful. What is the primary mechanism of action of the medication that should be administered via the intramuscular route?

It directly provides glucose to the bloodstream.
It stimulates the liver to break down glycogen into glucose. (Correct answer)
It facilitates the transport of glucose from the blood into the cells.
It stimulates the pancreas to release stored insulin.

Correct answer: It stimulates the liver to break down glycogen into glucose.

In this scenario, Glucagon would be administered IM. Glucagon's primary mechanism of action is to stimulate the liver to convert its stored glycogen into glucose (a process called glycogenolysis) and release it into the bloodstream, thereby raising the blood glucose level. It does not directly provide glucose or stimulate insulin release.

Question 147: A 55-year-old male is found to be in a perfusing, wide-complex bradycardia with a heart rate of 38 bpm. He is pale, diaphoretic, and has a blood pressure of 80/50 mmHg. According to AEMCA-level protocols, which intervention should be prioritized after establishing IV access and administering oxygen?

Immediate application and initiation of transcutaneous pacing (TCP) (Correct answer)
Administering a 1 mg dose of epinephrine
Preparing for synchronized cardioversion
Administering Atropine 0.5 mg IV

Correct answer: Immediate application and initiation of transcutaneous pacing (TCP)

In a patient with symptomatic, unstable bradycardia, particularly with a wide QRS complex or high-degree AV block, transcutaneous pacing (TCP) is the treatment of choice and should not be delayed. While Atropine may be considered, it is often ineffective in wide-complex bradycardias or high-degree blocks, making TCP the more definitive and immediate treatment.

Question 148: During a mass casualty incident (MCI), a patient is found apneic after repositioning the airway. Under START triage, this patient is tagged:

Immediate (Red)
Delayed (Yellow)
Minor (Green)
Expectant (Black) (Correct answer)

Correct answer: Expectant (Black)

Under START triage, a patient who remains apneic after airway repositioning is tagged Expectant (Black) because resources are insufficient to save them during MCI.

Question 149: A patient with stable angina reports chest pain that begins with exercise and resolves with rest within 5 minutes. This is BEST described as which type of angina?

Classic (stable) angina (Correct answer)
Unstable angina
Prinzmetal's (variant) angina
Microvascular angina

Correct answer: Classic (stable) angina

Classic stable angina is predictably triggered by exertion or stress and consistently relieved by rest or nitrates within a few minutes.

Question 150: Which phase of a disaster response involves returning EMS systems to their normal state of readiness?

Preparedness
Mitigation
Response
Recovery (Correct answer)

Correct answer: Recovery

The recovery phase focuses on restoring normal operations, restocking supplies, and returning personnel and systems to readiness.

Question 151: Which assessment finding best differentiates cardiogenic shock from hypovolemic shock in a trauma patient?

Jugular venous distension with pulmonary edema (Correct answer)
Flat neck veins with cool, clammy skin
Tachycardia with narrow pulse pressure
Altered mental status with hypotension

Correct answer: Jugular venous distension with pulmonary edema

Cardiogenic shock causes fluid backup, presenting with JVD and pulmonary edema, while hypovolemic shock presents with flat neck veins and no pulmonary edema.

A-EMCA Theory Exam

The Advanced Emergency Medical Care Assistant (A-EMCA) Theory Examination is administered by the Ontario Ministry of Health and Long-Term Care. Passing this exam is required for certification as a Primary Care Paramedic in Ontario.

150

Questions

180 min

Time Limit

70%

To Pass

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