10 free AEMT practice questions: Toxicology and Overdose Management

Intranasal and intramuscular only, with the other routes left to paramedics: Intranasal and intramuscular are the two routes most services train first. Those two routes are not the limit for an AEMT. The national scope of practice model also gives the AEMT the intravenous and intraosseous routes for naloxone.

Intravenous only once access exists, with intranasal saved for a refusal: Giving naloxone through the line this patient already has is good clinical sense. Using the line is a preference, and scope does not require it. Nothing restricts the nasal route to a patient who might refuse.

Any route is in scope, though each dose needs online medical direction: Medical direction does control a lot of what an AEMT gives. Naloxone runs on standing protocol in nearly every system that carries it. You do not need an online call before each dose.

Repeat the intranasal dose in the opposite nostril and reassess: A repeat intranasal dose makes sense when the first dose was absorbed and was just too small. Both nostrils here are packed with clot. A second dose in the other nostril lands on the same blocked lining as the first one.

Conclude the cause is not an opioid and continue ventilation alone: A drug that does nothing is a real reason to rethink the cause. Before you give up on an opioid, ask whether the naloxone ever reached the bloodstream. Nothing in this question says the naloxone did, and the pinpoint pupils and slow breathing still fit an opioid.

Wait a further ten minutes before repeating any naloxone dose: Naloxone is not instant, and patience prevents over-reversal. Ten more minutes does nothing for a blocked route. The drug is still sitting on clot instead of reaching the receptors.

Obtain a signature on the refusal form and clear the scene promptly: A signed refusal form is the normal paperwork when a patient declines care. A signature alone says nothing about the risk of re-sedation. This refusal needs that risk explained and written down.

Leave a naloxone kit with the family and advise them how to use it: Community naloxone saves lives, and leaving a kit with the family is a useful thing to do. A kit does not replace the crew. If this patient stops breathing again, a family member with a kit has no equipment to ventilate the patient.

Request law enforcement to hold the patient for a psychiatric evaluation: Overdose calls often involve mental health problems, and a hold can look like a way to keep this patient safe. This patient is alert and oriented. Nothing in this question supports taking away the patient's right to decide.

Anticholinergic: poisoning matches almost everything here. Dilated pupils, a fast heart, a hot patient, and an altered mental status all fit. Anticholinergic skin is hot and dry, and this patient is soaked with sweat.

Cholinergic: poisoning also makes the skin wet. Everything else goes the other way. A cholinergic patient has constricted pupils and a slow heart rate, and this patient has dilated pupils and a pulse of 138.

Sedative-hypnotic: Alcohol and benzodiazepines are a fair guess for an unknown ingestion at a festival. Sedative-hypnotic patients are quiet, slow, and hypotensive. This patient is agitated, with a blood pressure of 168/96.

Opioid: An opioid overdose also gives you constricted pupils and a depressed patient. Opioid skin is normal and dry. An opioid patient is not losing saliva, urine, and stool the way this patient is.

Anticholinergic: poisoning fits a patient who is hot and dry, with dilated pupils. This patient is wet everywhere, with constricted pupils.

Sympathomimetic: The wet skin and the respiratory rate of 30 fit a sympathomimetic patient. A sympathomimetic drug also gives you dilated pupils and a racing heart. This patient's pupils are constricted and the pulse is 44.

Apply the automated external defibrillator and follow the advisory prompts: A pulse of 38 is dangerously slow, and the automated external defibrillator is right there. An AED is for a patient in cardiac arrest who has no pulse. This patient still has a pulse and is answering questions.

Give oral glucose for the weakness and monitor the mental status: Weakness and slow answers do fit low blood sugar, and checking a glucose level is always fair. Oral glucose does nothing for a pulse of 38 and a pressure of 76/44. Those numbers come from the metoprolol this patient swallowed.

Give high-concentration oxygen and transport without vascular access: Getting this patient moving toward the hospital is right, and skipping the line saves a minute. A pressure of 76/44 needs fluid, and fluid needs vascular access. A line already in place also lets the paramedic give the antidote the moment the paramedic arrives.

Advise the family to watch for symptoms at home overnight: A normal exam makes watching at home sound reasonable. The liver injury from acetaminophen shows up days later. By then, the window to prevent the liver injury has closed.

Have the patient drink water to dilute the tablets before transport: Drinking water to dilute a poison is common home first aid. Water does not reduce how much acetaminophen gets absorbed. Drinking water also raises the risk of vomiting in a patient you are about to move.

Give activated charcoal on scene and reassess the mental status: Activated charcoal does bind acetaminophen, and this ingestion is recent. Most ambulances no longer carry charcoal, and giving charcoal is a protocol decision, not a routine step. Even when charcoal is available, it never replaces transport.

The generator exhaust displaced enough oxygen in the room to cause hypoxia: Running a generator indoors overnight does not use up enough of the room's oxygen to cause this. The danger is the carbon monoxide the patients breathe in, which binds to hemoglobin. Low room oxygen also would not explain why the pulse oximeter reads normal in patients who are not getting enough oxygen.

Hyperventilation from anxiety is producing a falsely elevated reading: Hyperventilation does not make a pulse oximeter read falsely high. Breathing rate does not change how a standard pulse oximeter works. Anxiety also would not explain why three coworkers have the same findings.

The patients are in the early, compensated stage of shock: Compensated shock is a blood flow problem where the blood pressure is still holding up. Compensated shock does not explain a falsely normal oxygen saturation. Shock also does not fit three patients with headache, nausea, and confusion after the same exposure.

Withhold charcoal because acetaminophen is not adsorbed by activated charcoal: Withholding charcoal is right for a substance charcoal cannot bind. Acetaminophen is not one of those substances. Timing is what matters here, and this ingestion was 20 minutes ago, well inside the window of about an hour.

Give activated charcoal immediately without contacting medical control first: Activated charcoal is the right drug for this patient, given in the wrong order. You need the order from medical control before you give charcoal, not after.

Withhold charcoal because the patient's level of consciousness is decreased: A decreased level of consciousness is a reason to withhold charcoal. This patient is alert, oriented, and speaking clearly, so that reason does not apply.

Improvement confirms CO poisoning; reduce oxygen to titrate SpO₂: The improving symptoms do confirm carbon monoxide poisoning. Turning the oxygen down to match the SpO₂ is the mistake. The SpO₂ is not reliable in carbon monoxide poisoning, because the sensor cannot tell oxygen from carbon monoxide.

Normal SpO₂ rules out CO poisoning; consider psychogenic causes: A normal SpO₂ would reassure you in most patients. In carbon monoxide poisoning, the sensor reads carbon monoxide as oxygen, so a normal SpO₂ does not rule the poisoning out. The headache, the dizziness, and the furnace malfunction all point to carbon monoxide.

Normal SpO₂ confirms adequate oxygenation; discontinue oxygen: An SpO₂ of 99% usually means the patient has enough oxygen. Here the 99% is a false reading caused by carbon monoxide on the hemoglobin. Stopping the oxygen takes away the treatment that is making this patient better.