EMR EMR Care Fundamentals 2 — Questions and Answers

Question 1: Which of the following is the MOST appropriate action when an EMR encounters a patient with suspected spinal injury who requires airway management?

Head-tilt chin-lift with hyperextension
Jaw-thrust maneuver with manual cervical spine stabilization (Correct answer)
Neck hyperextension to maximize airway opening
Nasopharyngeal airway insertion without stabilization

Correct answer: Jaw-thrust maneuver with manual cervical spine stabilization

The jaw-thrust maneuver with manual in-line cervical spine stabilization is the correct technique for patients with suspected spinal injury, as it opens the airway without extending the neck.

In patients with suspected cervical spine injury (mechanism of injury suggesting high-energy trauma, altered mental status after trauma, or neck pain), the head-tilt chin-lift must be avoided because cervical extension can worsen a spinal injury. Instead, the jaw-thrust maneuver is used: the EMR places both hands on either side of the patient's head, stabilizes the neck in a neutral position, and thrusts the mandible forward using the fingers. This opens the oropharynx without neck movement. A second rescuer should maintain manual in-line stabilization throughout.

Question 2: A patient is in moderate respiratory distress with oxygen saturation of 94% on room air. Which oxygen delivery device should the EMR use?

Nasal cannula at 1–2 LPM
Non-rebreather mask at 15 LPM
Simple face mask at 6–10 LPM (Correct answer)
No supplemental oxygen is needed above 90%

Correct answer: Simple face mask at 6–10 LPM

A simple face mask at 6–10 LPM delivers 35–60% FiO2 and is appropriate for a patient in moderate distress with SpO2 of 94%. A non-rebreather mask is reserved for severe hypoxia or critical conditions requiring near-100% FiO2.

Oxygen delivery should be matched to patient need. A nasal cannula (1–6 LPM) delivers 24–44% FiO2 and is appropriate for mild hypoxia or patients who cannot tolerate a mask. A simple face mask (6–10 LPM) delivers 35–60% FiO2 and suits moderate respiratory distress. A non-rebreather mask (10–15 LPM) delivers 60–90%+ FiO2 and is for severe hypoxia, shock, or critical illness. A patient with SpO2 94% and moderate distress warrants intermediate support — a simple face mask is the appropriate choice, though escalation to NRB is indicated if the patient deteriorates.

Question 3: An EMR is treating a patient in anaphylactic shock following a bee sting. The patient has hives, facial swelling, and audible wheezing. Which medication is most indicated?

Oral diphenhydramine (Benadryl)
Epinephrine auto-injector (EpiPen) (Correct answer)
Nitroglycerin sublingual tablet
Aspirin 325 mg

Correct answer: Epinephrine auto-injector (EpiPen)

Epinephrine is the first-line treatment for anaphylaxis. It reverses bronchospasm, reduces urticaria and angioedema, and counteracts cardiovascular collapse. An auto-injector (0.3 mg IM for adults) should be administered immediately.

Anaphylaxis is a life-threatening systemic allergic reaction involving multiple organ systems. When a patient presents with signs of anaphylaxis (urticaria, angioedema, wheezing, hypotension, or stridor), epinephrine is the treatment of choice — not antihistamines, which are too slow. Epinephrine 0.3 mg (1:1000) given intramuscularly in the anterolateral thigh via auto-injector is the standard EMR intervention. It acts within minutes to cause vasoconstriction (reversing hypotension), bronchodilation (reversing bronchospasm), and reduces mucosal edema. Diphenhydramine is an adjunct, not primary treatment. Nitroglycerin is for chest pain, aspirin for ACS.

Question 4: When applying direct pressure to control bleeding from a deep wound, how long should pressure be maintained before reassessing?

30 seconds
At least 5 minutes without lifting the dressing (Correct answer)
1 minute, then check if bleeding has stopped
Until the patient arrives at the hospital

Correct answer: At least 5 minutes without lifting the dressing

Direct pressure should be maintained continuously for at least 5 minutes without lifting the dressing. Lifting the dressing too soon disrupts clot formation and restarts bleeding.

Effective bleeding control with direct pressure requires patience. Clot formation involves platelet aggregation and fibrin cross-linking, which takes several minutes. Lifting or removing the dressing before the clot forms disrupts the clot and restarts hemorrhage. The EMR should maintain firm, continuous pressure for a minimum of 5 minutes. If blood soaks through, additional dressings should be placed on top (not replacing the original dressing) and pressure maintained. If direct pressure fails for extremity wounds, a tourniquet should be applied. The goal is always hemostasis before transport.

Question 5: A patient with suspected diabetic emergency is conscious, able to swallow, and has a blood glucose reading of 52 mg/dL. What should the EMR do?

Administer oral glucose gel between the cheek and gum (Correct answer)
Administer glucagon intranasally
Place the patient supine and withhold glucose until ALS arrives
Administer insulin to stabilize the glucose level

Correct answer: Administer oral glucose gel between the cheek and gum

A conscious patient with hypoglycemia who can swallow safely can receive oral glucose gel. The EMR administers glucose orally to raise blood sugar and reverse hypoglycemic symptoms.

Hypoglycemia (blood glucose below 60–70 mg/dL) with symptoms (altered mental status, diaphoresis, weakness) requires prompt glucose administration. If the patient is conscious and has an intact gag reflex, oral glucose gel can be administered between the cheek and gum. EMRs carry oral glucose as one of their few pharmacological interventions. Glucagon (intranasal or IM) is an option for unconscious patients with hypoglycemia, typically administered by ALS providers or bystanders with pre-authorization. Insulin would dangerously worsen hypoglycemia and is never given in this situation.

Question 6: Which of the following is a sign of tension pneumothorax that may be found during the primary assessment?

Bilateral equal breath sounds with tachycardia
Absent breath sounds on the affected side, tracheal deviation away from the injury, and distended neck veins (Correct answer)
Crackles (rales) and productive cough
Bradycardia and hypotension with warm skin

Correct answer: Absent breath sounds on the affected side, tracheal deviation away from the injury, and distended neck veins

Tension pneumothorax presents with absent or markedly diminished breath sounds on the affected side, tracheal deviation toward the unaffected side, distended neck veins (JVD), hypotension, and tachycardia.

Tension pneumothorax occurs when air enters the pleural space and cannot escape, causing progressive lung collapse and mediastinal shift. Classic signs include absent breath sounds on the injured side (collapsed lung), tracheal deviation away from the injury (mediastinum pushed toward the uninjured side), jugular venous distension (impaired venous return due to increased intrathoracic pressure), hypotension (reduced cardiac output), and tachycardia. This is a rapidly fatal condition requiring needle decompression. EMRs should recognize these signs and expedite ALS intercept or transport. Note: tracheal deviation is a late sign and may not always be apparent.

EMR EMR Care Fundamentals 2

Which of the following is the MOST appropriate action when an EMR encounters a patient with suspected spinal injury who requires airway management?