EMR Primary Patient Assessment 2 — Questions and Answers
Question 1: During the primary assessment of an unresponsive patient, what is the FIRST action an EMR should take after ensuring scene safety?
- Open the airway using head-tilt chin-lift
- Form a general impression and determine the patient's level of responsiveness (Correct answer)
- Check for a carotid pulse for 10 seconds
- Apply supplemental oxygen via non-rebreather mask
Correct answer: Form a general impression and determine the patient's level of responsiveness
The primary assessment begins with forming a general impression and determining level of responsiveness (LOC) using AVPU — Alert, Verbal, Pain, Unresponsive — before proceeding to airway, breathing, and circulation.
After ensuring scene safety and donning PPE, the EMR forms a general impression of the patient and determines their level of responsiveness using the AVPU scale. Only after establishing responsiveness does the EMR move on to assessing the airway (A), breathing (B), and circulation (C). This sequence ensures that the most critical life threats are identified in a systematic manner and resources are directed appropriately.
Question 2: When assessing the airway of a conscious adult patient, which method is preferred to open the airway?
- Jaw-thrust maneuver
- Head-tilt chin-lift maneuver (Correct answer)
- Tongue-jaw lift
- Sellick maneuver
Correct answer: Head-tilt chin-lift maneuver
The head-tilt chin-lift is the preferred technique for opening the airway in a conscious patient with no suspected spinal injury. The jaw-thrust is reserved for patients with suspected cervical spine trauma.
The head-tilt chin-lift maneuver is the standard method for opening the airway in patients without suspected spinal injury. It works by tilting the head back and lifting the chin, which moves the tongue away from the posterior pharynx and opens the airway. The jaw-thrust maneuver is used when spinal injury is suspected because it minimizes neck movement. The Sellick maneuver (cricoid pressure) is used during intubation attempts to reduce aspiration risk and is not an airway-opening technique.
Question 3: During circulation assessment in the primary survey, an EMR identifies major external bleeding. What is the immediate priority?
- Apply a tourniquet to the nearest proximal joint
- Control bleeding with direct pressure before continuing the assessment (Correct answer)
- Complete the head-to-toe secondary survey first, then control bleeding
- Administer oral fluids to compensate for blood loss
Correct answer: Control bleeding with direct pressure before continuing the assessment
Major external bleeding identified during the primary assessment must be controlled immediately with direct pressure. Life-threatening hemorrhage takes priority over completing the remainder of the assessment.
In the primary assessment, the circulation step (C) includes checking for a pulse, assessing skin color/temperature/moisture, and identifying and controlling major external bleeding. If life-threatening bleeding is found, the EMR must control it immediately using direct pressure before moving on. Delaying hemorrhage control to complete the assessment can result in preventable death. Oral fluids are never given for hemorrhagic shock, as they can cause aspiration and do not replace volume rapidly enough.
Question 4: Which of the following best describes the purpose of the primary assessment in EMS care?
- To obtain a complete medical history from the patient
- To identify and correct immediately life-threatening conditions (Correct answer)
- To document vital signs for hospital handoff
- To determine the mechanism of injury
Correct answer: To identify and correct immediately life-threatening conditions
The primary assessment is designed to rapidly identify and correct immediately life-threatening conditions affecting airway, breathing, and circulation. It is not focused on history-taking or documentation.
The primary assessment (also called the initial assessment) is a rapid, systematic evaluation performed on every patient to identify conditions that are immediately life-threatening. This includes airway obstruction, absent or inadequate breathing, and major hemorrhage or absent pulse. Any life threat found is corrected on the spot before moving forward. Medical history, vital signs documentation, and mechanism of injury are addressed during the secondary assessment and history-taking phase, which occurs after immediate threats are managed.
Question 5: An EMR arrives to find a 55-year-old male who is unresponsive and not breathing normally. He has no pulse. What is the correct sequence of actions?
- Open airway, give 2 rescue breaths, then begin chest compressions
- Call for AED, begin 30 chest compressions, open airway, give 2 rescue breaths
- Begin 30 chest compressions, open airway, give 2 rescue breaths, attach AED as soon as available (Correct answer)
- Give 5 rescue breaths before starting chest compressions
Correct answer: Begin 30 chest compressions, open airway, give 2 rescue breaths, attach AED as soon as available
Current CPR guidelines (C-A-B) direct rescuers to begin chest compressions first (30 compressions), then open the airway and give 2 rescue breaths. The AED should be used as soon as it is available.
Since 2010, the American Heart Association updated CPR guidelines from A-B-C (Airway-Breathing-Compressions) to C-A-B (Compressions-Airway-Breathing). This change ensures that chest compressions — the most critical component — are started with minimal delay. For an adult with no pulse and no normal breathing, the EMR performs 30 chest compressions at a rate of 100-120/min and depth of at least 2 inches, then opens the airway and delivers 2 rescue breaths (1 second each). An AED should be attached and used as soon as it arrives on scene.
Question 6: When performing the primary assessment, what does the 'E' in the AVPU scale stand for?
- Eyes open spontaneously
- AVPU does not contain the letter E (Correct answer)
- Emergent response
- External stimuli responsive
Correct answer: AVPU does not contain the letter E
The AVPU scale consists of Alert, Verbal, Pain, and Unresponsive — there is no 'E' in the AVPU mnemonic.
AVPU is a rapid neurological assessment tool used during the primary survey to gauge a patient's level of consciousness. A = Alert (patient is awake, aware, and responds spontaneously), V = Verbal (patient responds to verbal stimuli), P = Pain (patient responds only to painful stimuli), U = Unresponsive (no response to any stimulus). There is no 'E' in the scale. The Glasgow Coma Scale (GCS), a more detailed tool, uses Eyes, Verbal, and Motor components — this may cause confusion with AVPU.
EMR Primary Patient Assessment 2
During the primary assessment of an unresponsive patient, what is the FIRST action an EMR should take after ensuring scene safety?