Emergency Medical Services Flashcards

A 58-year-old male presents with syncope preceded by 10 minutes of chest tightness. On-scene ECG shows a PR interval of 0.28 seconds with progressively lengthening PR intervals until a QRS is dropped, then the cycle repeats. Which intervention is MOST appropriate before transport?

Answer: IV atropine 0.5 mg and reassess

This ECG pattern describes Mobitz Type I (Wenckebach) second-degree AV block. In a symptomatic patient (syncope), atropine 0.5 mg IV is the first-line pharmacological intervention. Transcutaneous pacing is reserved for patients unresponsive to atropine or those with Mobitz Type II or third-degree block. Synchronized cardioversion is inappropriate for a bradycardic conduction disorder. While Wenckebach is generally benign, this patient is symptomatic and requires treatment.

During a mass casualty incident (MCI) involving a chemical spill, a responder in Level C PPE is treating patients in the warm zone. A casualty is conscious, breathing rapidly, with pinpoint pupils, excessive salivation, and muscle fasciculations. What is the CORRECT sequence of initial treatment?

Answer: Administer atropine 2–4 mg IM immediately, then pralidoxime 1–2 g IV

This patient exhibits classic organophosphate/nerve agent toxidrome (SLUDGE/DUMBELS). Atropine is the priority antidote, counteracting muscarinic overstimulation; 2–4 mg IM is the initial adult dose, repeated every 5–10 minutes until secretions dry. Pralidoxime (2-PAM) is given concurrently or immediately after atropine to reactivate acetylcholinesterase and reverse nicotinic effects (fasciculations), but atropine takes precedence. Treatment should begin in the warm zone — delaying for transport to cold zone risks death. Diazepam alone does not address the underlying toxidrome.

An adult patient in cardiac arrest receives high-quality CPR. After the second shock for refractory ventricular fibrillation, amiodarone 300 mg IV is administered. Return of spontaneous circulation (ROSC) is achieved. The patient remains comatose with a GCS of 5. Core temperature is 36.8°C. Per current AHA/ILCOR guidelines for post-cardiac arrest care, the MOST appropriate temperature management target is:

Answer: Strict normothermia at 36°C with aggressive fever prevention for at least 72 hours

Current ILCOR/AHA guidelines (updated after TTM2 trial results) recommend targeted temperature management (TTM) at a constant temperature between 32–36°C, with many centers now targeting 36°C and aggressively preventing fever (>37.7–38°C) for at least 72 hours post-arrest. The key principle is fever prevention — hyperthermia worsens neurological outcomes. The earlier protocol of mandatory 32–34°C cooling has been replaced by evidence supporting 36°C with strict fever prevention as equally effective. Allowing uncontrolled temperature rise or rewarming above normothermia is harmful.

A 32-year-old pregnant patient (34 weeks gestation) presents with sudden onset of painless, bright red vaginal bleeding after a minor motor vehicle collision. Vital signs: BP 90/60 mmHg, HR 128 bpm, SpO₂ 96%. The uterus is soft and non-tender. Which condition is MOST likely, and what is the CRITICAL management consideration that differs from standard hemorrhagic shock protocol?

Answer: Placenta previa; avoid digital vaginal examination and position in left lateral decubitus

Painless bright red antepartum bleeding with a soft, non-tender uterus strongly suggests placenta previa. The critical EMS management distinction is to NEVER perform a digital vaginal examination, as this can precipitate catastrophic hemorrhage by disrupting the placenta overlying the cervical os. Left lateral decubitus positioning relieves aortocaval compression and improves uteroplacental perfusion. Abruption typically presents with painful, dark bleeding and a rigid uterus. Uterine rupture is not managed with field C-section. Aggressive crystalloid beyond permissive resuscitation targets can worsen coagulopathy.

A pediatric patient (8 years, ~25 kg) presents in pulseless electrical activity (PEA) arrest. After 2 minutes of CPR and epinephrine 0.01 mg/kg IV, PEA persists. The team identifies narrow-complex PEA with no breath sounds on the left and tracheal deviation to the right. The correct immediate intervention and epinephrine re-dosing interval are:

Answer: Needle decompression left 4th–5th ICS AAL; repeat epinephrine every 3–5 minutes

Absent breath sounds left + tracheal deviation to the right = tension pneumothorax on the LEFT. Needle decompression for tension pneumothorax in pediatric patients is best performed at the 4th–5th intercostal space, anterior axillary line (AAL) as current evidence and ATLS/PHTLS guidelines increasingly favor this landmark over 2nd ICS MCL due to greater chest wall thickness and reliability in obese or muscular patients. Epinephrine repeat dosing in pediatric cardiac arrest remains every 3–5 minutes. Pericardiocentesis addresses tamponade, not pneumothorax, and epinephrine is not contraindicated.

In the Dubai EMS system operating under DHA protocols, a paramedic arrives on scene to find a patient who is a valid Do-Not-Resuscitate (DNR) order holder in full cardiopulmonary arrest. The patient's adult child, present on scene, is demanding full resuscitation efforts. Which action is MOST consistent with DHA medico-legal and ethical standards?

Answer: Honor the valid DNR order, provide comfort measures, and document the family's objection

Under DHA and UAE Federal Law principles, a legally valid DNR order represents the patient's autonomous advance directive and is binding on EMS providers. A single family member's verbal demand does not override a valid DNR — patient autonomy and prior expressed wishes take legal and ethical precedence over surrogate pressure. The appropriate response is to honor the DNR, provide comfort-focused care (analgesia, dignity), clearly document the family's objection in the patient care record, and notify receiving facility and medical direction as per protocol. Requiring unanimous family consent or routine physician authorization to honor an already-valid DNR is not aligned with DHA standards.