10 free EMT practice questions: Shock (All Types) & Hemorrhage Control

Apply an occlusive dressing first, then a tourniquet: The occlusive dressing is the right treatment for the chest wound, and it goes on right after the tourniquet. Sealing the chest first leaves the thigh artery spurting while you expose the chest, seal the hole, and secure the dressing.

Manage both wounds simultaneously: Working both wounds at once is what happens when there are enough providers, like two crews on scene. The question asks for an order. One provider working alone has to pick an order. Splitting your attention gives each wound only part of the care it needs. The tourniquet still goes on first.

Assess the chest wound only; it is always the priority: A sucking chest wound is loud and hard to ignore. This option says the chest is always the priority, and that is wrong. Massive bleeding comes before airway and breathing in the trauma sequence, because arterial bleeding is the fastest cause of death in trauma. Looking only at the chest leaves the thigh bleeding with nobody controlling it.

Nasal cannula at 2-3 L/min to avoid overoxygenation: A nasal cannula at low flow is right for a comfortable patient with mild hypoxia who will not keep a mask on. A COPD patient at home on 2 liters is a good example. A stable chest pain patient with a saturation in the low nineties is another. This patient has a systolic pressure of 80 and only one working lung. There is no such thing as giving too much oxygen to a patient in shock during an ambulance transport. Holding back oxygen to avoid a harm that might happen, while a real harm is already happening, gets the priorities backwards.

BVM ventilation at 20 breaths/min with 15 L/min of oxygen: A bag-valve mask (BVM) is right for a patient whose own breathing is not enough, meaning too slow, too shallow, or absent. This patient is struggling but is still breathing on their own. Positive pressure is dangerous in a tension pneumothorax. Every forced breath pushes more air into the pleural space and raises the pressure in the chest. Higher chest pressure cuts the blood return to the heart even more. If this patient's breathing fails, you will ventilate carefully at a normal rate instead of 20 breaths a minute. You do not start with the BVM.

Room air until the paramedic arrives to decompress the chest: Room air is for a patient with no hypoxia and no shock. This patient has both. Waiting for the paramedic is not a treatment. Fill the wait with the highest oxygen you can give, and keep moving toward the hospital.

The patient is recovering; the drop in systolic pressure means his heart rate is normalizing: The heart rate does slow down as a patient truly recovers from shock. Nothing in this question shows the heart rate slowing. The lower blood pressure and the new confusion mean perfusion is getting worse, not better.

The patient is developing hypertension and will improve shortly: Hypertension means a high blood pressure. This patient's blood pressure is 88/50, which is low.

The patient's condition is stable and no change in care is needed: A stable patient has the same vital signs and mental status on each check. This patient's systolic pressure fell from normal to 88, and the patient became confused. Both changes call for more care right away, not routine transport.

The patient is in decompensated shock and requires immediate high-concentration oxygen and rapid transport: Decompensated shock means low blood pressure or a badly altered mental status. This patient has neither. The blood pressure is 122/78, and the patient is oriented to person, place, and time. Oxygen and prompt transport are fine for any shock patient, but the decompensated label is wrong.

The patient is experiencing anxiety from the collision, and the rapid pulse and moist skin reflect an emotional response: Anxiety after a crash can speed up the pulse. Calling this an emotional response ignores the perfusion findings. A pulse of 110 with pale, moist skin in a patient with a broken femur points to early compensated shock, not anxiety alone.

The patient's blood pressure and respirations are within normal limits, indicating perfusion is currently adequate: A normal blood pressure and normal respirations can look like good perfusion. In early shock, compensation holds the blood pressure up. The pulse of 110 and the pale, moist skin show the compensation has already started.

The patient's condition is stable because the blood pressure has not significantly changed: A blood pressure that barely changed can look like stability. In shock, the skin goes pale, cool, and clammy before the blood pressure ever moves. This patient's new pallor, cool and clammy skin, and rising heart rate are the early warning signs.

The vital signs show only minor changes and do not warrant urgent intervention: Small changes in the vital signs can be minor when nothing else moves. The blood pressure only went from 134/82 to 128/80, and that change is small. The skin went from warm and dry to cool and clammy, and the heart rate climbed from 98 to 118. That trend is the pattern you see before a patient decompensates, and it needs action now.

The patient's heart rate increase is a normal response to chest pain anxiety and does not indicate shock: Anxiety from chest pain can raise the heart rate. Anxiety alone does not explain skin that turned pale, cool, and clammy over the same 5 minutes. The skin change and the rising heart rate together point to worsening perfusion.

Reflex bradycardia is blunting the force of each ventricular contraction: Reflex bradycardia is a slow heart rate. This patient's pulse is 128, which is tachycardia. The heart is speeding up to make up for the smaller amount of blood pumped with each beat.

Ongoing blood loss from the chest wound is lowering the total volume of circulating blood: Ongoing blood loss is the usual cause of a narrowing pulse pressure in trauma. Blood loss leaves the neck veins flat. This patient's neck veins are distended, and the heart sounds are muffled. Blood is collecting around the heart, not leaving the vessels, and no external bleeding is reported.

Peripheral vasoconstriction is raising the systolic and diastolic pressures equally: Vasoconstriction is part of what is happening here. If the systolic and diastolic went up by the same amount, the pulse pressure would stay the same. This patient's systolic went down, from 116 to 100, while the diastolic went up. Only that split narrows the pulse pressure.

Cardiogenic shock: gives a low pressure and a fast pulse from a failing pump after a heart attack or from heart failure. The skin turns cool, pale, and clammy. This patient has warm, flushed skin and a fever of 102.8°F. Warm skin with a fever points to dilated vessels from an infection, not a failing pump.

Neurogenic shock: follows a spinal cord injury. The nerves that hold vessel tone stop working below the injury. Neurogenic shock gives you a low pressure with warm, dry, pink skin and a normal or slow pulse. This patient's pulse is 118, and nothing points to a spinal cord injury.

Hypoglycemia: causes an altered mental status with pale, cool, sweaty skin. No blood sugar is given in this question. The fever of 102.8°F and the warm, flushed skin point to an infection, not low blood sugar.

Leave the wound completely uncovered to allow air to escape: Leaving the wound open lets outside air keep coming in. The sucking sound tells you air is being pulled into the chest with each breath. Without a seal, more air enters the pleural space every time the patient breathes in, and the lung collapse gets worse. A dressing taped on three sides already gives trapped air a way out.

Perform needle decompression of the affected side: Needle decompression is for a tension pneumothorax, where trapped air builds pressure until it pushes on the heart and great vessels. Nothing in this question describes a tension, like low blood pressure or distended neck veins. Needle decompression is also a paramedic skill, not an EMT skill.

Pack the wound tightly with gauze to stop air movement: Packing gauze into a wound is for heavy bleeding from a junctional wound. You cannot pack a body cavity like the chest. Gauze is not occlusive, so air keeps moving through the hole with every breath and the lung stays unprotected.

Withhold further treatment until the blood pressure improves: His absent radial pulse and pressure of 78/50 already tell you he is in decompensated shock. Withholding treatment until the pressure improves only lets a treatable emergency get worse.

Give the patient sips of water: Sips of water would replace fluid by mouth. This patient is confused, so he cannot reliably protect his own airway. Giving him water by mouth puts him at risk for aspiration. A patient in shock gets nothing by mouth.

Apply ice packs to the skin: Ice packs on the skin are for a patient who is overheated, like a patient in heat stroke. This patient's problem is lost fluid, not heat. Cooling the skin does nothing for the fluid he has lost. A patient in shock needs to stay at a normal body temperature, not get cooled.

Hypovolemic shock: would fit a low blood pressure and a fast pulse after blood or fluid loss. Nothing in this call points to bleeding or fluid loss. The arm pain and nausea point to his heart.

Septic shock: comes with a fever and a source of infection. His history has neither one.

Obstructive shock: comes from a tension pneumothorax, cardiac tamponade, or a large clot in the lungs. He has no injury or history that points to any of those.