, Question 1
A restrained driver in a high-speed lateral impact has a palpable pelvic fracture,
hypotension, and a rigid abdomen. Which finding most strongly indicates the
need for immediate transport to a trauma center rather than scene stabilization?
A. Heart rate of 118 with warm extremities
B. Positive seatbelt sign across the abdomen with rebound tenderness
C. GCS of 14 with retrograde amnesia
D. Localized pelvic tenderness without instability
Correct Answer: B - Positive seatbelt sign across the abdomen
with rebound tenderness
RATIONALE
A seatbelt sign with peritoneal irritation suggests intra-abdominal
hemorrhage, a time-critical condition requiring surgical intervention.
Tachycardia with warm extremities may reflect compensated shock
but is less specific than peritoneal signs. GCS 14 and isolated pelvic
tenderness do not independently mandate immediate trauma-center
transport.
Question 2
During ventilation of an apneic patient with a supraglottic airway, compliance
suddenly decreases and oxygen saturation falls. Which action best reflects
current EMS airway management priorities?
A. Increase ventilation rate to 20/min
B. Confirm placement with waveform capnography and assess for
obstruction
C. Immediately remove the device and attempt blind digital intubation
D. Hyperventilate with 100% oxygen until saturation improves
Correct Answer: B - Confirm placement with waveform
capnography and assess for obstruction
Page 2
, RATIONALE
Waveform capnography is the standard for confirming and monitoring
airway device placement; loss of compliance with desaturation
suggests dislodgement or obstruction. Increasing rate or
hyperventilating can worsen outcomes via decreased venous return.
Blind digital intubation is not a current first-line intervention.
Question 3
A patient with suspected opioid toxicity has pinpoint pupils, respiratory
depression, and a systolic BP of 78. After naloxone, respirations improve but
hypotension persists. Which pathophysiologic mechanism best explains the
persistent hypotension?
A. Naloxone-induced histamine release
B. Opioid-mediated histamine and vagal effects on vascular tone
C. Co-ingestion of a sympathomimetic
D. Hypoxic myocardial depression with metabolic acidosis
Correct Answer: D - Hypoxic myocardial depression with
metabolic acidosis
RATIONALE
Opioid-induced respiratory depression causes hypoxia and acidosis,
which depress myocardial contractility and vascular responsiveness;
hypotension may persist even after ventilation improves.
Naloxone-induced histamine release is uncommon and not the primary
mechanism. Sympathomimetic co-ingestion would typically cause
hypertension and tachycardia.
Question 4
Which statement best reflects current evidence regarding spinal motion
restriction (SMR) in the prehospital setting?
A. Rigid backboards should be used for all trauma patients during
transport
Page 3
, B. SMR should be applied selectively based on mechanism and clinical
findings
C. Cervical collars alone are sufficient for all suspected spinal injuries
D. SMR is contraindicated in penetrating trauma to the torso
Correct Answer: B - SMR should be applied selectively based on
mechanism and clinical findings
RATIONALE
Current guidelines endorse selective SMR based on validated criteria,
avoiding unnecessary immobilization that can cause harm. Routine
backboard use is discouraged due to pressure ulcers and airway
compromise. Collars alone do not provide adequate restriction, and
SMR is not absolutely contraindicated in penetrating torso trauma.
Question 5
A patient with a history of heart failure presents with dyspnea, bibasilar
crackles, and JVD. Which prehospital intervention is most appropriate
according to current guidelines?
A. High-flow oxygen regardless of saturation
B. CPAP and nitroglycerin if BP permits
C. Rapid fluid bolus of 500 mL normal saline
D. Albuterol nebulizer as first-line therapy
Correct Answer: B - CPAP and nitroglycerin if BP permits
RATIONALE
CPAP plus nitroglycerin reduces preload and afterload, improving
pulmonary edema in hypertensive heart failure. High-flow oxygen is
titrated to saturation (94-98%) to avoid hyperoxia. Fluid boluses and
albuterol are not first-line for cardiogenic pulmonary edema.
Page 4
A restrained driver in a high-speed lateral impact has a palpable pelvic fracture,
hypotension, and a rigid abdomen. Which finding most strongly indicates the
need for immediate transport to a trauma center rather than scene stabilization?
A. Heart rate of 118 with warm extremities
B. Positive seatbelt sign across the abdomen with rebound tenderness
C. GCS of 14 with retrograde amnesia
D. Localized pelvic tenderness without instability
Correct Answer: B - Positive seatbelt sign across the abdomen
with rebound tenderness
RATIONALE
A seatbelt sign with peritoneal irritation suggests intra-abdominal
hemorrhage, a time-critical condition requiring surgical intervention.
Tachycardia with warm extremities may reflect compensated shock
but is less specific than peritoneal signs. GCS 14 and isolated pelvic
tenderness do not independently mandate immediate trauma-center
transport.
Question 2
During ventilation of an apneic patient with a supraglottic airway, compliance
suddenly decreases and oxygen saturation falls. Which action best reflects
current EMS airway management priorities?
A. Increase ventilation rate to 20/min
B. Confirm placement with waveform capnography and assess for
obstruction
C. Immediately remove the device and attempt blind digital intubation
D. Hyperventilate with 100% oxygen until saturation improves
Correct Answer: B - Confirm placement with waveform
capnography and assess for obstruction
Page 2
, RATIONALE
Waveform capnography is the standard for confirming and monitoring
airway device placement; loss of compliance with desaturation
suggests dislodgement or obstruction. Increasing rate or
hyperventilating can worsen outcomes via decreased venous return.
Blind digital intubation is not a current first-line intervention.
Question 3
A patient with suspected opioid toxicity has pinpoint pupils, respiratory
depression, and a systolic BP of 78. After naloxone, respirations improve but
hypotension persists. Which pathophysiologic mechanism best explains the
persistent hypotension?
A. Naloxone-induced histamine release
B. Opioid-mediated histamine and vagal effects on vascular tone
C. Co-ingestion of a sympathomimetic
D. Hypoxic myocardial depression with metabolic acidosis
Correct Answer: D - Hypoxic myocardial depression with
metabolic acidosis
RATIONALE
Opioid-induced respiratory depression causes hypoxia and acidosis,
which depress myocardial contractility and vascular responsiveness;
hypotension may persist even after ventilation improves.
Naloxone-induced histamine release is uncommon and not the primary
mechanism. Sympathomimetic co-ingestion would typically cause
hypertension and tachycardia.
Question 4
Which statement best reflects current evidence regarding spinal motion
restriction (SMR) in the prehospital setting?
A. Rigid backboards should be used for all trauma patients during
transport
Page 3
, B. SMR should be applied selectively based on mechanism and clinical
findings
C. Cervical collars alone are sufficient for all suspected spinal injuries
D. SMR is contraindicated in penetrating trauma to the torso
Correct Answer: B - SMR should be applied selectively based on
mechanism and clinical findings
RATIONALE
Current guidelines endorse selective SMR based on validated criteria,
avoiding unnecessary immobilization that can cause harm. Routine
backboard use is discouraged due to pressure ulcers and airway
compromise. Collars alone do not provide adequate restriction, and
SMR is not absolutely contraindicated in penetrating torso trauma.
Question 5
A patient with a history of heart failure presents with dyspnea, bibasilar
crackles, and JVD. Which prehospital intervention is most appropriate
according to current guidelines?
A. High-flow oxygen regardless of saturation
B. CPAP and nitroglycerin if BP permits
C. Rapid fluid bolus of 500 mL normal saline
D. Albuterol nebulizer as first-line therapy
Correct Answer: B - CPAP and nitroglycerin if BP permits
RATIONALE
CPAP plus nitroglycerin reduces preload and afterload, improving
pulmonary edema in hypertensive heart failure. High-flow oxygen is
titrated to saturation (94-98%) to avoid hyperoxia. Fluid boluses and
albuterol are not first-line for cardiogenic pulmonary edema.
Page 4
