10 free AEMT practice questions: Field Impression Formation

Acute myocardial infarction: a diagnosis, not a field impression. The presentation looks classic, and a specific name sounds more useful on the radio. Confirming an infarction takes lab work and imaging that no ambulance carries. Once you call it an MI on the radio, you tend to stop looking for anything else.

Noncardiac chest wall pain: takes the most dangerous cause off the list. Nothing on this call has ruled a cardiac cause out. Cool, diaphoretic skin with chest discomfort is exactly the pattern that leaves a cardiac cause near the top of the list.

Chest discomfort, as the patient reported it: Chest discomfort is the chief complaint, which is what the patient says is wrong. The field impression is what you think is happening. Repeating the complaint back gives the hospital nothing the patient did not already say. Staying inside your scope means you hedge the impression, not that you skip it.

Pelvic fracture: A pelvic fracture fits the down-and-under pathway. An unrestrained driver slides down, the knees hit the dashboard, and the force travels up the femurs into the pelvis. A bent steering wheel points to the up-and-over pathway, where the chest hits the wheel.

Spinal cord injury: A spinal cord injury is what you suspect with axial loading. Diving into shallow water, a fall landing on the head or feet, or a rollover can compress the spine along its length. A collapsed steering wheel shows a forward hit to the chest, not compression down the spine.

Burn injury: Burn injuries come from a fire, airbag propellant, hot fluids, or electrical contact at the scene. A bent steering wheel does not tell you any of those happened. Steering wheel damage is a blunt trauma clue for the chest.

An isolated injury to the head only (scalp, skull, and face): An injury to the head alone fits a single hit to the skull. A falling object or a blow during an assault puts all the force on one spot. A tumbling fall down stairs spreads the force across many surfaces. Being alert and oriented says nothing about the ribs, pelvis, or spine you have not palpated yet.

Isolated fractures of the lower extremities only (ankles, tibias, and femurs): Lower extremity fractures fit a controlled, feet-first fall from a height. The force travels up from the heels and injures the heel bone, the tibia, and the lumbar spine. A fall down stairs is not a controlled landing. The patient rolls and hits with whatever body part leads. Leg injuries are likely here too, just not by themselves.

Soft-tissue injuries only, without bone involvement (bruising and abrasions): Bruises and scrapes with no broken bones fit a low-energy event, like a younger patient slipping and falling from standing onto a flat floor. Twelve steps carry more energy than that, and an older adult's bones handle less of it. If you expect only bruises, you skip the palpation that would find a broken hip, rib, or spine.

Hip dislocation and pelvic ring injury: Lap belts can cause hip injuries. Hip dislocation is the pattern when the belt is worn too low, below the iliac crests. This belt mark is well above the hip bones.

Clavicle fracture and sternal injury: A clavicle fracture and sternal injury come from the diagonal shoulder strap of a three-point belt. The rear seat in this car has lap belts only, so no shoulder strap crossed this patient's chest.

Cervical spine and facial injury: Whiplash and facial injury are a common head-on crash pattern. This patient denies neck pain and has no facial injury. A rear-seat passenger belted at the waist is not thrown forward into the windshield.

The injuries are confined to the line between the two wounds: Drawing a straight line between the wounds is the simplest way to guess what was hit. A straight line is roughly right for a knife or another low energy wound. A rifle round can flatten, tumble, or ricochet inside the body. The pressure changes around the round also damage tissue away from its path.

The smaller wound is the entrance and predicts the depth of injury: Entrance wounds are usually described as small and neat, and exit wounds as larger and ragged. In the field you cannot reliably tell them apart. Even if you could, the entrance would not tell you how deep the injury goes. Count the wounds and treat what you find.

The size of the larger wound reflects the amount of internal damage: A bigger hole looks like a bigger injury. In penetrating trauma, the size of the outside wound does not match the damage inside. This patient's rigid abdomen, abdominal pain, and BP of 88/56 already point to damage much bigger than either skin wound.

Wrist injury, because a falling child extends the arms to break the fall: Wrist fractures are the classic low-fall injury in adults, who reach out a hand to catch themselves. A toddler's head is much heavier for the body than an adult's head, so the head hits first instead of the hands.

Ankle and knee injury, because the legs absorb the energy of a short fall: A feet-first landing sends the force up through the heel bones, the pelvis, and the spine. That pattern fits a patient who lands on the feet. A top-heavy toddler going over an edge does not land that way.

Clavicle injury, because the shoulder takes the first impact in a low fall: A clavicle fracture is a common injury in children. Clavicle fractures come from a fall onto the shoulder or an outstretched arm. A toddler's body shape makes the head lead the fall instead.

A definitive diagnosis of the underlying disease process, confirmed by the AEMT's assessment in the field: A definitive diagnosis is what a physician makes in the emergency department, with imaging and labs to confirm the disease. An AEMT does not have that certainty in the field. Calling a field impression a definitive diagnosis claims more than the AEMT can confirm.

A single vital sign or physical exam finding that by itself determines the patient's chief complaint: One number, like a glucose reading or an SpO2, can decide a single treatment on its own. A field impression is bigger than one number. You build a field impression from the pattern across the history, the exam, and the scene. Each single finding is only one part of that pattern.

An immediate general impression formed during the first 30-60 seconds of contact, before history or exam findings are gathered: The general impression is the quick look at how sick the patient is. You form the general impression in the first 30 to 60 seconds from appearance, breathing, and skin, before you have any history or exam findings. The general impression comes first and does not get updated. The field impression comes after it and keeps changing as you learn more.

Tension pneumothorax: Chest trauma with distended neck veins and a falling blood pressure does fit a tension pneumothorax. Trapped air collapses the lung on the injured side. You get decreased or absent breath sounds on that side, and later the trachea shifts toward the uninjured side. This patient's breath sounds are clear and equal in all fields, and the trachea is midline.

Hemothorax: Blunt chest trauma with shock and no outside bleeding is a reason to suspect a hemothorax. Blood in the chest presses on the lung on that side and decreases the breath sounds there. A hemothorax drains blood volume instead of distending the neck veins. This patient has clear, equal breath sounds and distended neck veins.

Intra-abdominal hemorrhage: A steering wheel injury with a fast pulse and low blood pressure can mean bleeding you cannot see in the abdomen. Losing blood empties the neck veins and does not muffle the heart sounds. This patient has distended neck veins, muffled heart sounds, and a soft, nontender abdomen.

Hypovolemic shock: what you assume first in a trauma patient with a low blood pressure. Hypovolemic shock gives you a fast pulse and pale, cool, clammy skin. This patient has a pulse of 52 and warm, dry skin. There is no bleeding, the chest is nontender, and the abdomen is soft.

Cardiogenic shock: comes from damage or disease of the heart itself. Those patients usually have chest discomfort and fluid backing up into the lungs. This patient dove into shallow water, has no chest discomfort, and has clear breath sounds in all fields.

Psychogenic shock: fainting. Blood supply to the brain drops for a short time, and the fainting ends once the patient is lying flat. This patient never lost consciousness and is still alert with a low blood pressure.

Pneumonia: A lung infection like pneumonia can cause chest pain, fast breathing, and a low SpO₂. Pneumonia builds over days and brings a fever, a cough, and abnormal breath sounds over the infected part of the lung. This patient got sick suddenly while walking, has no fever and no cough, and has clear breath sounds in all fields.

Acute pulmonary edema: fluid backing up into the lungs. Pulmonary edema can also cause sudden trouble breathing and a low SpO₂. Fluid in the air sacs gives you crackles, and in bad cases pink frothy sputum. The breath sounds here are clear and equal in all fields.

Spontaneous pneumothorax: A spontaneous pneumothorax also causes sudden chest pain on one side that gets worse with each breath. The air in the chest collapses the lung on that side, and you hear decreased or absent breath sounds there. This patient's breath sounds are clear and equal in all fields.