Emergency Medical Services Flashcards

A 45-year-old male is found unresponsive after a suspected opioid overdose. You administer 2 mg intranasal naloxone with no response after 2 minutes. Your next most appropriate action is:

Answer: Administer a second dose of naloxone and prepare for repeated dosing due to potential fentanyl involvement

With potent synthetic opioids such as fentanyl and carfentanil, standard naloxone doses may be insufficient. DHA/ACLS-aligned protocols support repeat dosing every 2–3 minutes and anticipating multiple doses. The absence of response does not confirm cardiac arrest without a full pulse check and rhythm assessment. Withholding naloxone to prevent withdrawal is never appropriate in an unresponsive patient.

During a mass casualty incident (MCI) triage, a patient is breathing at 32 breaths per minute, has a radial pulse, and follows simple commands. Under the START triage system, this patient should be tagged:

Answer: Red (Immediate)

Under START triage, a respiratory rate >30 breaths/minute alone places a patient in the Red (Immediate) category, regardless of pulse or mental status. The threshold of 30 rpm is a hard cutoff in START — it overrides the otherwise reassuring findings of a palpable radial pulse and obedience to commands.

A 28-year-old pregnant woman at 36 weeks gestation presents in cardiac arrest. You have been performing high-quality CPR for 4 minutes without ROSC. Which intervention is most critical to maximize both maternal and fetal survival at this point?

Answer: Perform perimortem cesarean delivery within the next minute if ROSC is not achieved

Current AHA and ERC guidelines recommend perimortem cesarean delivery (PMCD) beginning at 4 minutes of arrest in a near-term pregnancy (≥20 weeks), with delivery ideally completed by 5 minutes ('4-and-5 rule'). Relieving aortocaval compression is important but is achieved with manual uterine displacement during CPR — full lateral positioning makes compressions ineffective. Delaying PMCD beyond 5 minutes significantly worsens outcomes for both mother and neonate.

An EMS crew responds to a patient with a tension pneumothorax. After needle decompression at the 2nd intercostal space, midclavicular line, the patient's condition does not improve. The MOST likely reason and correct next step is:

Answer: Needle length was insufficient to reach the pleural space; perform a second needle decompression at the 4th/5th intercostal space, anterior axillary line

Studies show that the traditional 2nd ICS MCL site has a high failure rate — chest wall thickness frequently exceeds standard 14 g needle length (3.25 cm), especially in obese patients. Current TCCC and PHTLS guidelines now recommend the 4th/5th ICS anterior axillary line (AAL) as the preferred or alternate site, with lower failure rates due to thinner chest wall. Repeating at the same failed site without repositioning perpetuates the failure.

A 60-year-old male is in refractory ventricular fibrillation (VF) after 3 defibrillation attempts, 3 mg epinephrine, and 300 mg amiodarone IV. Which of the following is the MOST appropriate next pharmacological intervention according to advanced resuscitation protocols?

Answer: Administer a second bolus of 150 mg amiodarone IV

Per AHA ACLS guidelines, a supplemental dose of amiodarone 150 mg IV may be given for recurrent or refractory VF/pVT after the initial 300 mg bolus. Lidocaine is an alternative if amiodarone is unavailable, not a 'next step' after amiodarone. Sodium bicarbonate is not routinely indicated in refractory VF without confirmed severe hyperkalemia or TCA toxicity. Magnesium is specifically indicated for Torsades de Pointes, not refractory VF of unknown cause.

An EMS provider arrives at a scene where a patient has a traumatic amputation of the right forearm with uncontrolled hemorrhage. A tourniquet has been applied 3 cm above the wound but bleeding persists. The MOST likely cause and correct intervention is:

Answer: The tourniquet is venous-occlusion only; tighten until bleeding stops or apply a second tourniquet proximal to the first

A tourniquet that does not stop bleeding is most commonly not tight enough to achieve arterial occlusion — it may be compressing veins only, worsening hemorrhage. The correct response is to tighten the existing tourniquet until bleeding ceases, or apply a second tourniquet immediately proximal if the first cannot achieve occlusion. TCCC/TECC guidelines specify 2–3 inches (5–7.5 cm) above the wound as correct placement, but 3 cm above is the problem of insufficient distance only if proximal anatomy prevents occlusion — the primary issue here is insufficient pressure, not positioning.