WFR - Wilderness First Responder Wilderness CPR and Life Support Questions and Answers — Questions and Answers
Question 1: Which of the following statements best describes a primary difference in the approach to Cardiopulmonary Resuscitation (CPR) in a wilderness versus an urban setting?
- The ratio of chest compressions to breaths is changed from 30:2 to 15:2 in the wilderness.
- In the wilderness, rescuers may have specific protocols to stop CPR after a set period if resuscitation is futile. (Correct answer)
- Chest compressions are performed at a slower rate (80/min) in the wilderness to conserve rescuer energy.
- Rescue breaths are not performed in the wilderness due to the high risk of disease transmission.
Correct answer: In the wilderness, rescuers may have specific protocols to stop CPR after a set period if resuscitation is futile.
Due to prolonged transport times and limited resources, wilderness medicine protocols include specific criteria for terminating resuscitation efforts (e.g., after 30 minutes of CPR without a return of spontaneous circulation in certain non-hypothermic situations). In an urban setting, CPR is almost always continued until care is transferred to a higher medical authority. The compression-to-breath ratio and rate remain the same (30:2 at 100-120/min), and rescue breaths are a critical component of CPR.
Question 2: You are managing an unresponsive patient who was involved in a significant fall and you suspect a cervical spine injury. When you check for breathing, you find they are making gurgling sounds. What is the most appropriate technique to open and maintain their airway?
- Head-tilt, chin-lift maneuver.
- Placing the patient in the recovery position.
- Jaw-thrust maneuver with spinal motion restriction. (Correct answer)
- Performing a blind finger sweep to clear the airway.
Correct answer: Jaw-thrust maneuver with spinal motion restriction.
The jaw-thrust maneuver is the preferred method for opening the airway in a patient with a suspected spinal injury because it can be performed with minimal movement of the head and neck. The head-tilt, chin-lift maneuver is contraindicated as it manipulates the cervical spine. A finger sweep should only be done if a solid obstruction is visible, and the recovery position is for an uninjured, breathing patient.
Question 3: During your primary assessment of an unresponsive adult patient, you determine they are not breathing but have a definite carotid pulse. What is the correct intervention according to WFR life support protocols?
- Begin cycles of 30 chest compressions and 2 breaths.
- Roll the patient into the recovery position and monitor the pulse.
- Immediately apply an AED and follow the prompts.
- Provide 1 rescue breath every 6 seconds. (Correct answer)
Correct answer: Provide 1 rescue breath every 6 seconds.
The patient is in respiratory arrest, not cardiac arrest, because a pulse is present. The correct treatment is to provide rescue breaths to oxygenate the blood. The current guideline for an adult is to provide 1 breath every 6 seconds (10 breaths per minute). Starting chest compressions (CPR) is incorrect as the heart is still beating. An AED is only used for cardiac arrest and would not be effective.
Question 4: According to Wilderness Medicine guidelines, which of the following is an accepted reason to discontinue CPR on a non-hypothermic patient in a remote setting?
- The patient's pupils become fixed and dilated.
- A second rescuer has not arrived after 10 minutes.
- The rescuer is physically exhausted to the point of being unable to continue safely. (Correct answer)
- The patient has been in cardiac arrest for only 15 minutes.
Correct answer: The rescuer is physically exhausted to the point of being unable to continue safely.
In a wilderness context, rescuer safety and viability are paramount. Continuing CPR to the point of complete exhaustion can endanger the rescuer and the rest of the group. Wilderness protocols specifically identify rescuer exhaustion as a valid reason to terminate resuscitation efforts, alongside other criteria like the return of spontaneous circulation, transfer of care, the scene becoming unsafe, or meeting specific criteria for non-viability after a set time (often 30 minutes).
Question 5: You have just pulled an unresponsive, apneic patient from a cold lake. What is the most important initial emphasis in the resuscitation of this drowning victim?
- Performing abdominal thrusts to clear water from the lungs.
- Providing two initial rescue breaths before starting chest compressions. (Correct answer)
- Immediately beginning with high-quality chest compressions.
- Prioritizing rapid rewarming before initiating any CPR.
Correct answer: Providing two initial rescue breaths before starting chest compressions.
Cardiac arrest in drowning victims is typically secondary to hypoxia (lack of oxygen). Therefore, the initial priority is to provide oxygen. The standard of care is to give two initial rescue breaths as soon as the airway is opened, before proceeding to chest compressions. Attempting to clear water from the lungs with abdominal thrusts is ineffective and delays resuscitation. While rewarming is important, it should not delay the start of CPR.
Question 6: You are treating a severely hypothermic patient who goes into cardiac arrest. An AED is available. After delivering the first shock, the patient remains in a shockable rhythm. What is the most appropriate next action regarding the AED?
- Do not deliver any more shocks until the patient has been actively rewarmed to 86° F (30° C).
- Deliver a second shock immediately without performing CPR in between.
- Increase the shock energy on the AED before delivering the next shock.
- Continue to follow the AED's prompts for analysis and shocks while performing high-quality CPR. (Correct answer)
Correct answer: Continue to follow the AED's prompts for analysis and shocks while performing high-quality CPR.
Current wilderness medicine and AHA guidelines recommend following standard AED protocols even for hypothermic patients. This means continuing high-quality CPR and following the AED's prompts for analysis and shocks as they are indicated. While older protocols suggested limiting shocks, modern guidance emphasizes treating a shockable rhythm as it is detected, concurrently with rewarming efforts.
WFR - Wilderness First Responder Wilderness CPR and Life Support Questions and Answers
Which of the following statements best describes a primary difference in the approach to Cardiopulmonary Resuscitation (CPR) in a wilderness versus an urban setting?