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10 free AEMT practice questions: Trauma Assessment and Fluid Resuscitation

These are real questions from the same bank the app draws from. Each one is written to the NREMT AEMT content specifications and kept inside the AEMT scope of practice. Pick an answer and you get the full rationale, including why the other three options are wrong.

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Question 1 of 10

An AEMT is working a critical trauma patient who has just been freed from a vehicle and is trying to keep scene time inside the Platinum 10 Minutes. Which task belongs on scene rather than en route?

Show the answer and rationale

Correct answer · Sealing an open chest wound

Sealing an open chest wound is one of the few tasks that belong on scene for a critical trauma patient. The others are securing the airway, controlling life-threatening bleeding, and extrication. Everything else gets done in the back of the ambulance on the way in. For any task, ask whether the patient will die in the next few minutes without it. An open chest wound lets air into the pleural space with every breath. Sealing the open chest wound passes that test. A splint, an IV line, and a set of vital signs are all real care. None of them is worth the minutes this patient needs to get to a surgeon. The Platinum 10 Minutes is part of the Golden Period. The Golden Period is the idea that surgery should start within about an hour of the injury. Every minute on scene comes out of that hour.

Why the others are wrong

Splinting a deformed lower leg: Splinting cuts down bleeding at a fracture, and a splint is the best pain control you carry that is not a drug. Splinting is not on the list of work that earns scene time. You can splint the deformed lower leg en route and get the same result.

Establishing two large-bore intravenous lines: Two large-bore IV lines are the right plan for an unstable trauma patient. You place them en route, not on scene. IV fluid does not fix internal bleeding, and the line runs just as well in a moving ambulance.

Obtaining a complete set of baseline vital signs: Vital signs matter, and you will take them over and over on the way in. You can get the first set once you are rolling. Taking a full set on scene costs minutes this patient does not have.

Question 2 of 10

A 44-year-old patient was crushed between two vehicles and has pelvic instability on the initial exam. There is no external bleeding and the abdomen is soft and non-tender. The heart rate is 130, the skin is pale and cool, and the radial pulse is weak. Which statement best explains these perfusion findings?

Show the answer and rationale

Correct answer · The unstable pelvis can hold an entire blood volume out of sight

This patient is in hypovolemic shock from bleeding into the pelvis. The pelvis is unstable after a crush injury. The heart rate is 130, the skin is pale and cool, and the radial pulse is weak. There is no blood on the outside, so the blood is going somewhere you cannot see. An unstable pelvis can hold an entire blood volume. A closed femur fracture can hold one to two liters in the thigh, and one side of the chest can hold about three liters. An unstable pelvis is the most dangerous fracture you can feel in the field. When you cannot see the bleeding, judge the blood loss from the mechanism and the fracture. With a mechanism like this one, assume a fast heart rate is from bleeding, and get a pelvic binder on.

Why the others are wrong

The soft abdomen makes a major internal bleed unlikely, so look elsewhere: A soft, non-tender abdomen would be reassuring if the abdomen gave you good early findings. In trauma the abdomen can stay soft while liters of blood build up inside. The pelvis in this patient can hold enough blood on its own to explain the shock.

Pelvic pain alone can drive a heart rate this high through catecholamine release: Pain does raise the heart rate, and a crushed pelvis hurts a lot. Pain does not make the skin pale and cool or the radial pulse weak. Pale, cool skin and a weak pulse come from the blood vessels clamping down after blood loss.

With no external bleeding, the weak pulse points to a primary cardiac problem: Looking for a cardiac cause makes sense on a medical call with no clear reason for the weak pulse. This patient was crushed between two vehicles and has an unstable pelvis. The fast heart rate is the body making up for blood loss. A fast heart rate from blood loss is hypovolemic shock, not a heart problem.

Question 3 of 10

An 84-year-old patient fell down a flight of stairs and has a suspected pelvic injury with pale, cool skin and a weak radial pulse. After the second increment of isotonic crystalloid the AEMT hears new crackles at both lung bases and the patient's work of breathing has increased. What should the AEMT do next?

Show the answer and rationale

Correct answer · Slow or stop the infusion and reassess the patient

This patient is developing pulmonary edema from fluid overload. After the second increment of fluid, you hear new crackles at both lung bases. The patient is also working harder to breathe. New crackles mean the fluid you are giving is backing up into the lungs. Slow or stop the infusion, then reassess. Crackles are fluid in the alveoli and small airways. Rhonchi are a coarser rattle from mucus in the large airways. Mixing up crackles and rhonchi leads you to the wrong fluid decision. Older patients have less heart reserve, so they handle both blood loss and too much fluid worse than younger patients. Listen to the lungs after every increment, not just once at the start.

Why the others are wrong

Finish the weight-based volume, then reassess the patient: Finishing the weight-based volume sounds like completing the treatment. The fluid is split into increments so you can reassess between them and stop early. New crackles are your reason to stop short.

Keep the infusion running and raise the oxygen concentration: More oxygen is reasonable for harder breathing, and more oxygen can help the saturation for a while. The fluid is still coming in through the line and backing up into the lungs. An older patient with little reserve keeps getting worse until the fluid slows.

Change the fluid to Lactated Ringer's and continue the infusion: Lactated Ringer's is closer to plasma than normal saline, and many trauma systems prefer it for large volumes. Both are isotonic crystalloid, and both back up into the lungs the same way. The problem here is how much fluid, not which fluid.

Question 4 of 10

A 3-year-old patient was struck by a car. On arrival the child was pale with a heart rate of 160. The AEMT rechecks four minutes later and finds the heart rate is now 62 with slow, shallow breathing and no improvement in skin color. What does the change most likely indicate, and what is the priority?

Show the answer and rationale

Correct answer · Profound hypoxia; begin oxygenation and assisted ventilation now

This child's heart rate dropped from 160 to 62 because of profound hypoxia. A child raises cardiac output almost entirely by speeding up the heart. The fast heart rate was the warning sign. A heart rate that falls back down does not mean the danger went away. In an injured child, bradycardia usually means profound hypoxia, and it is a sign that cardiac arrest is close. Children compensate hard and long, then get worse all at once. That's why the drop from 160 to 62 came so fast. The breathing is now slow and shallow, and the skin is still pale. Nothing about this child is getting better. Give oxygen and start assisting ventilations now.

Why the others are wrong

Improving perfusion; continue the current plan and reassess in five minutes: A heart rate coming down from 160 toward normal can look like improvement. This child's skin is still pale, and the breathing has slowed. Those findings say the child is getting worse, not better.

Rising intracranial pressure; elevate the head about 30 degrees: A falling heart rate after a head strike can be Cushing's, from rising pressure inside the skull. Cushing's also brings a rising blood pressure, a widening pulse pressure, and irregular breathing. In an injured child, hypoxia is a far more common cause of a slow heart rate.

A vagal response to pain; reassess after splinting and analgesia: Pain can cause a vagal response, and a child hit by a car is in pain. A vagal response is brief and goes away on its own. Four minutes after a heart rate of 160, this child has slow, shallow breathing and pale skin. A vagal response does not explain those findings.

Question 5 of 10

A 6-year-old patient fell from a second-story window onto grass. The blood pressure is 78/50 mmHg, the heart rate is 148, capillary refill is 4 seconds, and the skin is pale and cool. The child answers questions slowly. How should the AEMT classify this child's perfusion?

Show the answer and rationale

Correct answer · Decompensated shock, because the systolic is below 70 plus twice the age

This child is in decompensated shock. For children 1 to 10 years old, low blood pressure is a systolic below 70 plus twice the age in years. For a 6-year-old, the cutoff is 82. This child's systolic is 78, which is below 82. A pressure below the cutoff is what separates compensated shock from decompensated shock. Compensated means the body is still holding the pressure up. Decompensated means the body can no longer hold the pressure up. Shock has only those two stages. Learn the three pediatric cutoffs together. The cutoff is below 70 for an infant from one month to one year. From 1 to 10 years, the cutoff is below 70 plus twice the age. Over 10 years, the cutoff is below 90. These cutoffs mark decompensated shock, not shock itself.

Why the others are wrong

Compensated shock, because the heart rate is still defending the pressure: A heart rate of 148 does show the child compensating hard. Compensated shock is common in children because they hold their pressure up for a long time. Once the pressure falls below the age cutoff, the child has moved to decompensated shock.

Adequate perfusion, because a systolic near 80 is normal for a 6-year-old patient: Children run lower pressures than adults, so a systolic near 80 can sound normal for a 6-year-old. This child's cutoff is 82, and a systolic of 78 is below it.

Not yet stageable, because one set of vital signs is not a trend: Getting a second set of vital signs is good practice, and you should do it. This child already meets the definition of decompensated shock. The systolic of 78 is below the cutoff of 82. Waiting for a trend before you act costs the child time.

Question 6 of 10

An unstable trauma patient needs volume now. The AEMT can place a 20 gauge catheter in a visible hand vein immediately, or take slightly longer to place an 18 gauge in the antecubital fossa. Which statement should guide the choice?

Show the answer and rationale

Correct answer · The larger catheter in the proximal vein moves far more fluid per minute

Take the extra seconds and place the 18 gauge in the antecubital fossa. Gauge numbers run backward, so the 18 gauge is the larger catheter. Flow through a catheter rises steeply as the inside of the catheter gets wider. Flow also drops as the catheter gets longer, but width matters much more. The larger catheter in the bigger proximal vein moves far more fluid per minute than the 20 gauge in the hand. Resuscitation calls for an 18 gauge or larger. An unstable trauma patient needs volume now, so the faster line is worth the extra time.

Why the others are wrong

Catheter length matters more than lumen size, so the two sites flow alike: Catheter length does change flow. The width of the catheter changes flow much more. The 18 gauge and the 20 gauge in this question do not flow anywhere near the same.

The smaller catheter is less likely to infiltrate under pressure infusion: A smaller catheter is the right fit for a small, fragile vein or a line that only gives medications. This patient is unstable and needs volume now. Slow flow through the 20 gauge is the problem that matters here.

Gauge affects medication delivery but has little effect on gravity flow: Gauge does change how fast you can push medications. Gauge also controls how fast fluid runs, by gravity or under pressure. A larger catheter lets more fluid through every minute, and volume is what this patient needs.

Question 7 of 10

A 39-year-old patient with a suspected pelvic injury has a patent airway, clear and equal breath sounds, and a steady assisted ventilation rate. Over ten minutes the end-tidal carbon dioxide falls from 38 mmHg to 27 mmHg while the blood pressure stays at 104/70 mmHg. What is the most likely explanation?

Show the answer and rationale

Correct answer · Pulmonary blood flow is falling because systemic perfusion is deteriorating

The end-tidal carbon dioxide is falling because less blood is reaching the lungs, and this patient's perfusion is getting worse. End-tidal carbon dioxide depends on three things: the body making carbon dioxide, the blood carrying it to the lungs, and the breathing blowing it off. The airway is patent and the ventilation rate is steady, so the breathing has not changed. Nothing here suggests the body is making less carbon dioxide. Blood flow is the one left. Less blood reaching the lungs means less carbon dioxide gets breathed out. Capnography updates with every breath. A blood pressure cuff only updates every few minutes. That's why the end-tidal number dropped from 38 to 27 while the blood pressure stayed at 104/70. Reading the capnography waveform is in your scope, and reading a 12-lead ECG is not. Use capnography to watch the blood flow with every breath.

Why the others are wrong

The sensor has loosened and is sampling room air: A loose sensor sampling room air does drop the number, and you should always check the equipment. A loose sensor drops the reading suddenly and flattens the waveform. This patient's number slid steadily over ten minutes.

Carbon dioxide production has fallen as the patient calms down: Making less carbon dioxide is one of the three causes of a falling number. A patient calming down does not drop the number by 11 mmHg in ten minutes. A patient with a pelvic injury and a sliding number is far more likely to be losing blood.

This is normal variation, and the steady pressure is the better guide: The blood pressure really has not moved. Blood pressure is a late sign of shock, and end-tidal carbon dioxide is an early one. A steady pressure with a falling end-tidal number should worry you, not reassure you.

Question 8 of 10

A 19-year-old patient was the restrained driver in a rollover motor vehicle collision and walked away from the car. The patient is alert and fully oriented, denies neck or back pain, and has an obviously deformed and very painful right forearm. There is no numbness or weakness in any extremity. The vital signs are BP 126/78, P 104, and R 18. What should the AEMT do?

Show the answer and rationale

Correct answer · Apply spinal motion restriction before moving the patient

This patient has a distracting injury, so you cannot clear the spine in the field. The right forearm is obviously deformed and very painful. Pain that bad pulls the patient's attention to the arm. A spinal injury can be there and go unreported. Clearing a spine in the field only works when the patient can accurately report pain. The patient walked, is oriented, denies neck pain, and has no numbness or weakness. Those findings look reassuring, but none of them count when the exam cannot be trusted. Anything that could hide spinal pain means you apply spinal motion restriction. That includes a painful fracture, alcohol, or an altered mental status. The emergency department clears the spine later with imaging.

Why the others are wrong

Omit spinal motion restriction because the neck is not painful: Denying neck pain means something only when the patient is able to notice neck pain. A deformed, painful forearm is exactly what stops this patient from noticing. No complaint here does not mean no injury.

Omit spinal motion restriction because the patient walked at the scene: Walking away from the car sounds like proof that the spine is fine. Patients with unstable spine fractures, and even some partial spinal cord injuries, still walk. Walking is not one of the findings used to decide on spinal motion restriction.

Apply spinal motion restriction only if a deficit appears en route: Waiting for a deficit means waiting for the spinal injury to damage the spinal cord before you protect the spine. Spinal motion restriction is applied to prevent that damage, not to react to it.

Question 9 of 10

A 25-year-old patient sustained a closed fracture of the left lower leg in a bicycle crash and was splinted 45 minutes ago. The patient now reports pain far beyond what the injury first caused, and the pain worsens sharply when the toes are extended. The calf is tense and swollen, and a pulse is still palpable at the foot. What should the AEMT do next?

Show the answer and rationale

Correct answer · Loosen the splint and dressings and transport without delay

This patient has compartment syndrome. The pain is far beyond what the injury first caused, and the pain spikes when the toes are extended. The calf is tense and swollen. The muscles of the lower leg sit inside tough tissue called fascia, and fascia does not stretch. Bleeding and swelling inside the fascia raise the pressure in the calf. Once that pressure is higher than the pressure in the small vessels feeding the muscle, the muscle stops getting blood. The larger artery underneath stays open. That's why a pulse can still be felt at the foot. If you wait for the pulse to disappear, the muscle is already dead. Loosen the splint and the dressings now and keep the leg level with the heart. Transport without delay to a hospital that can do a fasciotomy.

Why the others are wrong

Tighten the splint to limit the swelling in the calf: Tightening a splint stabilizes a fracture and helps control bleeding. This calf is already being squeezed by its own rising pressure. A tighter splint squeezes the calf more, cuts off more of the blood flow the muscle needs, and makes the injury worse.

Elevate the leg well above the level of the heart: Raising a swollen leg above the heart is standard for ordinary fracture swelling, because it helps the fluid drain. The tense calf and the pain when the toes are extended point to compartment syndrome. The pressure in the calf is already keeping blood out of the muscle. Raising the leg lowers the blood flow into the muscle even more, and the muscle dies faster.

Apply ice packs over the calf and continue to monitor: Ice and monitoring are right for ordinary swelling after a splint. That kind of swelling settles with cold and time. This patient has pain far beyond the injury, and the pain spikes when the toes are extended. That pain pattern is compartment syndrome. Ice also tightens the blood vessels, which adds to the pressure that is already cutting off blood flow.

Question 10 of 10

An adult patient was pulled from farm machinery. There is a partially amputated forearm with bright red blood spurting from the wound, and the abdomen is rigid and diffusely tender. The skin is pale, cool, and diaphoretic. Vital signs are BP 82/50, P 128, R 26. A bystander is holding a shirt loosely against the arm, and blood continues to spurt from beneath it. Which action should the AEMT take first?

Show the answer and rationale

Correct answer · Apply a tourniquet proximal to the wound to control the arterial bleeding

This patient has arterial bleeding from the partly amputated forearm, and a tourniquet goes on first. Bright red blood keeps spurting out from under the shirt the bystander is holding loosely. Loose pressure is not stopping arterial bleeding. The patient is already in shock, with a blood pressure of 82/50, a pulse of 128, and pale, cool, diaphoretic skin. A tourniquet placed proximal to the wound shuts off the blood flowing in through the artery and stops the bleeding right away. Stop the bleeding before IV access, fluids, or more exam. None of those steps slow the bleeding.

Why the others are wrong

Establish two large-bore intravenous lines and begin an isotonic bolus first: Two large-bore IVs and a fluid bolus are right for hypovolemic shock, and this patient is in shock. The arm is still spurting blood. Fluid given now just pours back out of the open wound. Stop the bleeding first, then replace volume.

Perform a detailed abdominal exam to locate the internal bleeding source first: A rigid, tender abdomen points to bleeding inside the abdomen. You cannot control bleeding inside the abdomen in the field, no matter what the exam finds. You can control the spurting forearm right now. A detailed exam only tells you where the internal bleeding is.

Splint the forearm in a position of function to help slow the blood loss: Splinting can slow bleeding from a closed fracture by keeping the bone ends from moving. This forearm is partly amputated and spurting arterial blood. An open wound with arterial bleeding needs a tourniquet to shut off the artery. A splint does not replace the tourniquet.

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