A paramedic crew arrives at a high-speed motor vehicle collision where an electric utility pole has fractured and high-voltage power lines are resting across the vehicle's roof. The driver appears conscious and is shouting for help from inside. What is the most appropriate initial action?
Scene Assessment Triage
Question · Easy
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Short
What do the expiratory upstroke and alveolar plateau represent on a normal time capnogram?
Clinical preparation — Airway & Ventilation
Flashcard
A 34-year-old construction worker sustained an accidental deep laceration to his upper right thigh from an industrial saw. Upon paramedic arrival, bright red blood is spurting vigorously from the wound, and the patient is pale, diaphoretic, and confused. According to PHTLS primary survey guidelines, what is the immediate priority?
Question · Medium
Cheat sheet
A 42-year-old female is evaluated following a motorcycle crash. On examination, she opens her eyes only when asked loudly, produces incomprehensible groaning sounds, and flexes her arm to pull away from a painful trapezius squeeze (localizes/withdraws). What is her Glasgow Coma Scale (GCS) score?
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How should low or suddenly rising ETCO2 be interpreted during CPR?
You are the first paramedic unit arriving at a multi-vehicle highway pileup involving multiple casualties. Following Simple Triage and Rapid Treatment (START) guidelines, what is your initial action to categorize ambulatory casualties?
During a mass casualty incident triage sweep using the START protocol, a paramedic assesses a 28-year-old male who cannot walk. The patient is tachypneic with a spontaneous respiratory rate of 36 breaths per minute. According to START criteria, what triage category should be assigned immediately?
100 metronomes and 1 rescuer
Does a shark-fin waveform prove asthma, and does a flat trace prove esophageal intubation?
During a factory explosion mass casualty response, a paramedic assesses an adult victim who is motionless and apneic. The paramedic performs a manual jaw-thrust maneuver to open the airway, but no spontaneous breathing resumes. What is the correct triage assignment under START protocols?
A paramedic is triaging pediatric casualties following a school bus crash using the JumpSTART algorithm. A 5-year-old child is found apneic. The paramedic opens the airway, but the child remains apneic. A peripheral pulse is clearly palpable. What is the mandatory next step in the JumpSTART protocol?
Question · Hard
How do adult CPR ventilation and ventilation after traumatic brain injury differ in purpose?
An unrestrained driver involved in a frontal collision at 80 km/h is found with significant steering wheel deformation and a circular contusion across his anterior chest wall. Vital signs reveal blood pressure 90/60 mmHg, heart rate 118 bpm, and respiratory rate 24 breaths/min. Based on this mechanism of injury, which life-threatening occult injuries should the paramedic suspect most strongly?
A 19-year-old male was struck by a motor vehicle while crossing the street. On neurological examination, he opens his eyes only in response to trapezius pressure, produces no verbal sounds or vocalizations whatsoever, and exhibits abnormal flexion (decorticate posturing) in both upper extremities upon painful stimulation. What is his total GCS score?
Why are induction, paralysis and post-intubation care separate parts of RSI?
In a mass casualty incident using the START triage protocol, an adult female is unable to walk. Her spontaneous respiratory rate is 22 breaths per minute. On circulatory assessment, her radial pulse is absent, and her capillary refill time is 3.5 seconds. What triage category should be assigned?
Paramedics are dispatched to an industrial chemical spill at a manufacturing warehouse. As they approach, orange vapor is seen escaping from a storage building. What is the paramount rule for positioning the ambulance and establishing initial scene control?
Which patient can benefit from CPAP, and when may it be unsafe?
During the 'Disability' (D) evaluation of the primary survey in a 55-year-old male with acute altered mental status and slurred speech, which rapid diagnostic assessment must be performed immediately prior to considering advanced interventions?
A 30-year-old roofer falls 6 meters (20 feet) and lands directly onto a concrete pavement feet-first ('Lover's Leap' / Don Juan syndrome). He presents with severe bilateral heel pain, open calcaneal fractures, and intense lower back pain. Which secondary mechanical injury vector must the paramedic anticipate?
What is the priority in a cannot-intubate, cannot-oxygenate emergency?
A 40-year-old male involved in a train derailment cannot walk due to an open distal tibia fracture with controlled venous bleeding. He is alert, has a respiratory rate of 18 breaths/min, strong radial pulses, and appropriately follows complex two-step commands. Following START triage, which tag should be applied?
At what specific juncture during trauma patient management should the paramedic perform the head-to-toe secondary survey?
For a 4-year-old, what are the common cuffed and uncuffed ETT size estimates, and what confirms placement?
A 4-year-old child involved in a structural building collapse is non-ambulatory due to lower extremity entrapment debris. On assessment using JumpSTART, the child is breathing spontaneously at 28 breaths/min, has a palpable peripheral pulse, and responds purposefully by localizing a painful stimulus (AVPU = 'P'). What is the child's JumpSTART triage classification?
During the 'Exposure and Environmental Control' step (E) of the primary survey in a severely injured polytrauma patient, what critical physiological complication must paramedics actively combat?
Why can a supraglottic airway be useful without guaranteeing protection from aspiration?
A paramedic is evaluating an elderly patient who fell out of bed. The patient’s eyes remain closed until the paramedic speaks loudly, stating: 'Open your eyes, sir.' The patient immediately opens both eyes upon hearing the verbal prompt. What is the specific Eye Opening score on the GCS?
The first arriving paramedic crew at a major commercial airliner runway excursion encounters dozens of injured passengers fleeing the fuselage. What is the fundamental incident command obligation of the senior paramedic on this first-due unit?
In an asthma exacerbation, when is IM epinephrine indicated and how does GINA 2026 qualify oxygen?
A suicide bombing inside an enclosed marketplace produces multiple casualties. Which physiological organ structures are most susceptible to primary blast wave overpressure injury?
An unconscious 22-year-old diver is pulled from a shallow swimming pool with suspected cervical spine trauma and upper airway sonorous snoring. What is the initial airway maneuver recommended to open the airway while minimizing cervical spine manipulation?
Airway Respiration
Which ECG lead groups suggest inferior, lateral and anterior myocardial injury?
Clinical preparation — Cardiology & Resuscitation
A paramedic selects an i-gel supraglottic airway device for an unresponsive, deeply comatose 75 kg male trauma patient requiring airway protection. What is the appropriate i-gel size and key insertion principle for this patient?
During endotracheal intubation of a 50-year-old trauma patient, the paramedic visualizes only the epiglottis; the vocal cords and interarytenoid notch are completely obscured (Cormack-Lehane Grade III view). According to difficult airway algorithms, what is the best immediate corrective action?
Why is hypotensive suspected right-ventricular infarction a nitrate caution?
An intubated 60-year-old patient being transported to the hospital experiences a sudden loss of the rectangular capnography waveform, with end-tidal CO2 (EtCO2) dropping instantly to 0 mmHg. Chest rise ceases, but the mechanical ventilator continues cycling. What is the most likely cause?
A paramedic identifies a left-sided tension pneumothorax in a deteriorating polytrauma patient with hypotension, absent breath sounds, and tracheal shift. According to current PHTLS (9th/10th edition) and ATLS guidelines, what are the primary recommended anatomical locations for emergent needle chest decompression?
How do shockable and nonshockable adult cardiac arrest pathways differ?
The King LTS-D supraglottic airway device features two cuffs and a secondary distal port. What is the primary clinical function of the secondary distal channel in this device?
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