JIBC - Justice Institute of British Columbia Emergency Medical Responder Care Questions and Answers — Questions and Answers
Question 1: You arrive on scene to find an adult male who was stabbed in the right lateral chest. He is anxious, has a respiratory rate of 28, and complains of shortness of breath. During your primary survey, you note absent breath sounds on the right side. Which of the following is the MOST critical immediate intervention?
- Apply a high-flow oxygen mask and prepare for transport.
- Apply an occlusive dressing over the stab wound. (Correct answer)
- Perform a detailed secondary assessment to check for other injuries.
- Obtain a full set of vital signs, including a blood pressure reading.
Correct answer: Apply an occlusive dressing over the stab wound.
The patient's presentation of a penetrating chest injury with shortness of breath and absent breath sounds is highly suggestive of an open pneumothorax (sucking chest wound). The priority is to seal the wound to prevent more air from entering the pleural space and worsening the lung collapse. Applying an occlusive dressing is the most critical life-saving intervention in the primary survey for this condition.
Question 2: Which of the following is a primary contraindication for the use of an oropharyngeal airway (OPA)?
- The patient is unresponsive to painful stimuli.
- The patient has a suspected spinal injury.
- The patient has an intact gag reflex. (Correct answer)
- The patient is breathing spontaneously at a rate of 6 breaths per minute.
Correct answer: The patient has an intact gag reflex.
An oropharyngeal airway is contraindicated in patients who have an intact gag reflex. Inserting an OPA in a patient with a gag reflex can induce vomiting and aspiration, which can lead to a fatal airway obstruction. Unresponsiveness and slow respiratory rate are indications for airway support, and a suspected spinal injury does not preclude the use of an OPA, though care must be taken during insertion.
Question 3: You are assessing a known diabetic patient who is confused, has pale and sweaty skin, and is behaving aggressively. Which condition should you MOST suspect?
- Hyperglycemia
- Anaphylactic shock
- Hypoglycemia (Correct answer)
- A cerebrovascular accident (stroke)
Correct answer: Hypoglycemia
This patient is presenting with classic signs and symptoms of severe hypoglycemia (low blood sugar), including altered mental status (confusion, aggression), and diaphoresis (sweaty skin). While a stroke can cause confusion, the combination with pale, sweaty skin strongly points towards a diabetic emergency. Hyperglycemia typically has a slower onset and different signs, such as flushed, dry skin and a fruity odor on the breath.
Question 4: You are managing a patient with an isolated, closed, mid-shaft femur fracture. The patient is pale, has a heart rate of 120 bpm, and a blood pressure of 90/60 mmHg. After controlling any external bleeding, what is the MOST appropriate next step in managing this patient's condition?
- Focus solely on splinting the femur to reduce pain.
- Administer oral fluids to increase blood volume.
- Apply a traction splint immediately to realign the bone.
- Treat for hypovolemic shock with high-flow oxygen and keeping the patient warm. (Correct answer)
Correct answer: Treat for hypovolemic shock with high-flow oxygen and keeping the patient warm.
A femur fracture can lead to significant internal blood loss (up to 1.5 liters), and this patient's vital signs (tachycardia, hypotension) are indicative of hypovolemic shock. The most critical priority is to treat for shock by ensuring oxygenation, preventing heat loss, and preparing for rapid transport. While splinting is important, it should not delay the management of shock, which is the immediate life threat.
Question 5: When assessing a patient's complaint of chest pain, the 'P' in the OPQRST mnemonic is used to investigate which aspect of the pain?
- The patient's past medical history.
- The precise location of the pain.
- The perceived severity on a scale of 1-10.
- What makes the pain better or worse. (Correct answer)
Correct answer: What makes the pain better or worse.
In the OPQRST pain assessment mnemonic, 'P' stands for Provocation or Palliation. This involves asking the patient what provokes the pain (makes it worse) and what palliates it (makes it better). This helps to understand the nature of the pain and can provide clues to its cause.
Question 6: An adult patient is experiencing a severe anaphylactic reaction with respiratory distress and hypotension after a bee sting. According to BCEHS guidelines, what is the primary and most critical treatment an EMR can provide?
- Administering an antihistamine like diphenhydramine.
- Assisting the patient with their prescribed salbutamol inhaler.
- Administering epinephrine via auto-injector. (Correct answer)
- Applying a cold pack to the sting site to slow venom absorption.
Correct answer: Administering epinephrine via auto-injector.
For a patient with systemic signs of anaphylaxis, such as respiratory distress and hypotension, the primary and most important therapeutic intervention is the administration of epinephrine. Epinephrine is the only medication that can rapidly reverse the life-threatening effects of anaphylaxis. While other treatments may be considered, they are secondary to the prompt administration of epinephrine.
JIBC - Justice Institute of British Columbia Emergency Medical Responder Care Questions and Answers
You arrive on scene to find an adult male who was stabbed in the right lateral chest.
He is anxious, has a respiratory rate of 28, and complains of shortness of breath.
During your primary survey, you note absent breath sounds on the right side.
Which of the following is the MOST critical immediate intervention?