10 free AEMT practice questions: Head, Spinal, and Chest Trauma

Hold ventilation until a paramedic arrives to decompress the chest: Holding ventilation leaves this patient at 85% and 8 breaths a minute with no help at all. Hypoxia will kill this patient first. Needle decompression is a paramedic skill, so waiting gains nothing while the intercept is on the way.

Ventilate hard and fast to push past the rising airway resistance: Hard and fast ventilation makes the tension worse. Higher pressure and a faster rate force more air into a pleural space that cannot empty. More trapped air speeds up the mediastinal shift already showing in the distended neck veins.

Stop ventilating and place the patient on an NRB: An NRB gives oxygen to a patient who is moving air. At 8 shallow breaths a minute, this patient is not moving enough air. The oxygen on the face never reaches the alveoli in useful amounts.

Take over ventilations with a BVM before anything else: Ventilation matters, and you will get to it. This heart stopped from a blow that put it into a rhythm only a shock can fix. The AED is the one thing on the truck that treats that cause.

Give a fluid bolus through an intraosseous line in the tibia: Fluid does not treat ventricular fibrillation. IV or IO access is worth having after the rhythm is treated. Access never comes before the shock in a witnessed arrest with an AED already on scene.

Hold care at this level and wait for the paramedic intercept: Nothing here needs a paramedic. Compressions and AED defibrillation are the treatment, and both are within your scope. Waiting only lowers this patient's odds.

Tension pneumothorax from the crushing force on the chest: Tension pneumothorax gives you absent breath sounds on one side, tracheal deviation, and a falling blood pressure from mediastinal shift. None of those findings are in this question. A tension pneumothorax also does not explain cyanosis that stops at the crush line while the torso stays a normal color.

Cardiac tamponade from blunt force against the sternum: Cardiac tamponade also distends the neck veins, and blunt force to the sternum can cause it. Tamponade comes with muffled heart tones and a narrowing pulse pressure, as part of Beck's triad. This question gives you neither one. The neck veins in tamponade fill up because the heart cannot fill, not because blood got forced back into the head. Tamponade also does not explain the bleeding in the eyes or the sharp color change at the crush line.

Massive hemothorax from the ribs tearing the lung tissue: Massive hemothorax is bleeding into the chest. With that much blood loss, the neck veins go flat and the skin turns pale and cool. This patient has distended neck veins and a cyanotic face and neck, which is the opposite.

A single number taken at the time of the radio report: One number taken at the radio report is a single snapshot. A snapshot cannot tell the hospital which direction this patient is heading. The same number can belong to a patient who is steady or a patient who is crashing.

The worst single value seen at any point on the call: The worst value tells the hospital how low the patient got. The worst value says nothing about whether the patient is still getting worse. A patient who keeps declining needs different preparation than a patient who had one bad moment.

An estimate of how the patient will look on arrival: Guessing how the patient will look on arrival replaces real findings with a number nobody measured. Report what you saw and when you saw it.

Pack the ear canal with sterile gauze to stop the drainage: Packing is how you stop bleeding from a wound. In this ear canal, packing traps pressure that has nowhere else to go. The drainage comes from the fracture, and the drainage is not a bleed you need to control.

Irrigate the ear canal with sterile saline and then cover it: Irrigating flushes fluid, and anything sitting in the ear canal, inward toward a skull that is already broken open. Nothing about a leaking ear canal calls for flushing it in the field.

Suction the ear canal gently and save the fluid for the hospital: Suction puts negative pressure right against a fractured skull base and can pull contamination inward. Saving the fluid does not change anything about the care this child gets.

Release the patient, since the exam and vital signs are normal: A normal exam and normal vital signs are exactly what a lucid interval looks like. Releasing this patient because of a normal exam is how an arterial bleed gets found at home an hour later.

Release the patient with instructions to call if symptoms start: Releasing the patient with instructions puts the patient in charge of watching for symptoms. This patient could lose consciousness again without warning. Being knocked out by a blow to the temple calls for transport with someone watching.

Transport, and stop the neurologic checks now that they are normal: Transport is right, and stopping the checks is not. The checks are normal now, and later checks get compared against that normal baseline. Stopping the checks gives up the only way you have to catch a change.

Remove it now, so a cervical collar can be sized and applied: A collar helps hold the head in a neutral, stable position. This snug helmet is already holding the head that way. Pulling the helmet off to fit a collar moves the head when it did not need to move.

Remove it now, since every helmet comes off before transport: Some helmets do have to come off, like one that blocks the airway or fits loosely. No rule says every helmet comes off before transport. This helmet fits snugly, the airway is clear, and the helmet does not get in the way of your assessment.

Leave it on, but only until the patient is moved to the stretcher: Taking the helmet off at the stretcher adds a head movement right when you are already moving the patient. A helmet that fits snugly over a reachable airway stays on for the whole call.

The mechanism alone, since any collision can injure a spine: Any collision can injure a spine, so the mechanism is where you start. Using the mechanism alone is the mistake this rule is written to stop. If the mechanism alone decided, every collision patient would get spinal motion restriction no matter what the exam showed.

The patient's age alone, since older spines fracture easily: Age matters, because older spines fracture more easily. Age still does not replace the exam. This 69-year-old has no midline pain, no tenderness, and full strength and sensation.

The speed of the collision reported by the other driver: The speed reported by the other driver is not a finding on this patient. A number from someone else does not change what you found on your own exam.

Continue slowly until the head reaches a neutral position: Moving slowly toward neutral is right until the patient has pain or you feel resistance. This child has both. Easing past that stopping point is how a bone fragment reaches the spinal cord.

Reverse the movement and turn the head back further still: Turning the head further away from neutral is still movement, just in the other direction. Moving the other way carries the same risk to the cord. The rule is to stop, not to reverse.

Apply steady traction along the neck to ease it past this: Traction pulls along the length of the neck. Pulling on an injured cervical spine can pull an unstable segment apart. Traction is not part of restricting spinal motion.

Withhold fluid, warm the patient, and wait for the pressure to rise: Warming the patient is right, and withholding fluid while you wait is not. Holding fluid ignores the chance that this patient is also bleeding. A patient with a cord injury can bleed with no pain to tell you.

Give fluid until the pressure is normal, then stop the warming: Fluid is part of the plan, but only titrated to perfusion. Giving fluid until the pressure is normal overshoots that goal. Stopping the warming is backward, because these patients cannot constrict their vessels or shiver. They lose heat fast, and cold makes bleeding worse.

Begin a vasopressor infusion titrated to the blood pressure: A vasopressor may be what this patient needs. Vasopressors run as medicated infusions, and maintaining a medicated infusion is paramedic level under the national scope model. Requesting the intercept is how this patient gets that drug, and requesting the intercept is correct care.