Pretty Bay, Malta
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Normal mixed venous oxygen consumption (SvO2) in a healthy patient is:
Your patient is suffering a constellation of symptoms that can best be characterized with the pneumonic “Mad as a Hatter, Blind as a Bat, Dry as a Bone, Red as a Beet”. These symptoms characterize what category of drug ingestion?
The primary benefit of IABP insertion during the post-MI management of a patient with hemodynamic compromise is:
You are transporting a patient via ground critical care that is sedated, intubated, and on a mechanical ventilator. With this patient, what is the best method for knowing when to re-dose the sedatives and paralytics?
You are going to induce and paralyze a patient who was just extricated from beneath a fallen tree while cutting wood alone. It was estimated that the patient was entrapped for 3-4 hours before being found. The patient has a GCS of 7, pupils are sluggish to respond to light, he has recurrent vomiting, the pulse ox reads 92% on high flow, NIBP shows 102/62, MAP 72, pulse is 112. The patient has extensive pelvic and lower extremity trauma following the injury from the tree falling on him. In this situation, what would be your preferred agents for induction and paralysis?
Which of the following neonatal cardiac defects is most likely going to result in cyanosis?
What three syndromes fall under the “acute coronary syndrome” umbrella that critical care paramedics should be familiar with?
You are transporting a patient who suffered a diving accident and a subsequent decompression emergency. The patient is not being flown due to the gas law that explains the relationship between the ability of a gas to dissolve and the pressure in the closed container is?
Which arrangement of cot straps would afford the unresponsive patient the most security during interhospital transport?
Your critical care unit is dispatched to a community hospital to transport an obese post-cardiac arrest patient to a tertiary facility for ongoing care. Upon arrival, you find the ED physician and staff struggling to establish successful intubation using traditional intubation means. Currently the patient is has a normol cardic rhythym but hypotensive, and is being ventilated with an ETC in place. The staff is ventilating through tube #1 of the device to get breath sounds. What should the critical care provider consider doing?
Your patient sustained blunt force injury to the right eye which resulted in blood in the anterior chamber, and a visible fluid level. This presence of blood in the anterior chamber is defined as what type of ocular injury?
After a particularly busy shift, you find that you are more tired than usual. Which one of the following stressors of working a ground based critical care unit is the least likely contributor to how your feeling?
If a patient has increased tactile fremitus over the left lower lung lobe, which of the below is the LEAST likely cause of it?
You have just completed an RSI procedure on a septic patient with respiratory failure and you are now preparing for transport. Which of the following interventions may the critical care paramedic use to ensure there is no accidental dislodgement of patient tubes or wires while transporting?
Which of the following is a recognized negative effect of placing a patient on a mechanical ventilator, assuming all settings and patient variables were correctly set and no other contraindications to mechanical ventilations exist?
Which of the following psychotropic medications would the critical care paramedic most likely anticipate a toxic reaction to from accidental overdose?
While performing a bedside assessment of a patient prior to transport, you note that the patient has a new onset of ptosis in her left eye. This likely means damage to what nerve?
Your patient has serum sodium level of 116. In this situation, the critical care paramedic should be most concerned about the potential for:
You are called to ground transport an adult male who was struck by a car 5 days earlier. He received multiple surgeries to repair extensive lower extremity fractures, pelvic fractures, and internal injuries. Despite initial improvement, the patient has developed respiratory distress leading to failure, intubation and ventilator management. What is the likely reason for this deterioration several days later?
Your elderly patient has accidently ingested a large quantity of their oral potassium supplement and has a potassium level of 7.5 mEq/L. Calcium chloride may be administered by the critical care paramedic because:
Which of the following findings is the most common predictor of sepsis in a neonate?
When estimating the depth of endotracheal tube insertion during a neonatal critical care transport, the paramedic should estimate the depth of insertion by using what formula?
You are preparing to transport a trauma patient from a community hospital. The results of the iSTAT show an elevated lactate level. What does this finding indicate?
When can a patient with a tension pneumothorax receive pleural decompression without a real need to attach a butterfly valve to prohibit air entrainment into the pleural cavity?
While giving a lecture about TBI to a group of new hires, the critical care medic is discussing the “Monroe-Kelly” hypothesis. Someone in the class asks for an explanation of this, what should the critical care paramedic respond with?
During a long transport at night through a vastly remote part of your state, the driver falls asleep and wrecks the ambulance. You are mildly injured and your partner is more severely injured. Both the driver and patient are dead. What should your first action be at this point after you and your partner are safely away from the burning wreck of an ambulance?
An 18-year-old man sustains partial thickness burns to the anterior aspect of his chest and abdomen, as well as circumferential burns to his arms and legs. These burns cover approximately what percent of the patient’s total body surface area?
While transitioning from in-utereo dependence on the placenta for nourishment and oxygenation to extra-utero reliance on the pulmonary system, why does a neonate have an initial diminishment in oxygenation capability?
While assisting in the Emergency Department between critical care transports, a cheerleader has been brought in by EMS that has been stung multiple times is exhibiting signs of severe respiratory distress, along with urticaria, angioedema, and hypotension. Paramedics established an IV with normal saline solution and administered oxygen. Appropriate intervention at this time is to:
While reviewing some lab values for a trauma patient you are about to transfer to a definitive care facility, you note a lactate level of 4.6, a sodium level of 132, potassium of 3.9, BUN of 14, and a creatinine level of 0.8. Of these values, what is the greatest concern to the critical care provider?
During the morning brief with the pilot in charge, they explain that due to the weather today, the performance of the aircraft will be reduced as will the weight of the patient your crew will be able to transport. The weather in question is most likely?
During transport of a high risk OB/GYN patient, you elect to administer magnesium sulphate to inhibit premature contractions. Which of the following doses would be most appropriate?
You are transporting a patient with severe asthma between health care facilities. Enroute to the destination facility the patient enters into status asthmaticus. Besides the changes in breath sounds and oxygenation levels, what else should the critical care provider expect to see clinically?
Your 35-week obstetrical patient is experiencing variable decelerations in the foetal monitoring. These decelerations are considered:
The normal central venous pressure (CVP) in an adult patient is:
You are about to administer 100 mcg of fentanyl to your burn patient for management of pain that is listed “10” out of a “1 to 10” scale of intensity. The fentanyl is supplied in a vial that has 250 mcg in 5ml. How many millilitres of medication should you administer?
When managing a paediatric patient, the loss of certain reflexes can alert the critical care paramedic to the integrity of the patient’s CNS. To this end, as a child becomes increasingly unresponsive, they lose their reflexes in which of the below orders?
When transporting a female in her 3rd trimester of pregnancy, what should the critical care paramedic do first if they note a downward trend in the systolic pressure according to the NIBP?
While reviewing the x-rays of a pediatric patient with respiratory distress prior to transfer, you note a “steeple sign” finding in the neck region. This finding is a hallmark radiographic finding for which of the following conditions?
If you are switching an intubated and mechanically ventilated patient that is on SIMV to A/C mode per the receiving facility request, what one medication will you most likely administer?
Your patient is an unrestrained driver who impacted the windshield in a high speed collision. Prior to departing the ED with this patient, you review the face x-ray and note that he has multiple facial fractures involving the bilateral orbits, ethmoid, mandible, and sphenoid sinus bones. The diagnostic name given to this facial fracture pattern is:
You are called to transfer a patient from a small community hospital to the regional trauma centre for definitive care. When you arrive, the ED physician advises you the patient is being transferred because of a widened mediastinum on his chest X-ray. This finding is most consistent with what injury?
Which of the following best describes vesicular breath sounds as heard on a patient with no pulmonary deficits?
When contemplating the insertion of an umbilical catheter in the neonate, the critical care paramedic will need to recall what aspect of the umbilical vascular anatomy?
The release of angiotensin II impacts the cardiovascular system in what manner?
You are called to ground transport an adult male who was struck by a car 5 days earlier. From this situation, he received multiple surgeries to repair extensive lower extremity fractures, pelvic fractures, and internal injuries. Despite initial improvement, the patient has developed increasing respiratory distress leading to intubation and mechanical ventilation on SIMV mode, with light sedation. The FiO2 is at 0.9, and the rate is set at 12/min although the patient is breathing at 20/min spontaneously. What changes to this treatment should the critical care provider make?
You are transporting via critical care ground unit, a patient who has documented toxicity of atenolol and oxycodone from an intentional medication overdose. Traditional therapy for the patient’s unresponsiveness, bradycardia, and hypotension has failed. You partner asks you about the administration of glucagon. Why may this drug be beneficial in this patient?
You have a patient who due to their size and characteristics of facial structures, has been impossible to intubate after 3 attempts by both crew members. With PPV and insertion of a KING airway, the best oxygen saturation attained is 87%. What should be the next course of action for the critical care provider prior to departing on your 1 hour transport to the receiving facility?
You find yourself in the back of a prehospital ALS unit for a patient experiencing a suspected MI. After getting into the back of their ambulance, the medic hands you a 12-Lead and says “What do you think?” Upon examining the EKG, the critical care paramedic should use what morphologic finding to confirm proper lead placement?
While teaching at the local community college in an EMS program, a basic student asks you what it is called when the umbilical cord is wrapped around the baby’s neck during delivery. You would respond:
You are preparing to transport a patient from an outlying immediate care facility back to the university hospital. The patient is a child, who is a known ASA overdose. Based on the suspected arterial and venous lab values found in this condition, what medication may be warranted while still enroute?
The transfer of a critical patient from an outlying facility to the hyperbaric chamber would most likely be due to what type of exposure?
You are called to ground transport an adult male who was struck by a car 5 days earlier. From this situation, he received multiple surgeries to repair extensive lower extremity fractures, pelvic fractures, and internal injuries. Despite initial improvement, the patient has developed increasing respiratory distress leading to application of CPAP with 10 cmH20 and an FiO2 of 0.85. The pulse oximeter is 86% and the vitals are dropping. What changes to this treatment should the critical care provider make?
While transporting a patient with a left ventricular assist device (LVAD), what assessment finding do they typically not have?
The critical care paramedic medical crew is assisting a prehospital unit with the delivery of a baby. If it turned into a precipitous delivery, the critical care team should anticipate what other problem?
Pulmonary embolism has what affect on the V/Q ratio?
You are preparing to transfer a patient out of the ICU and note they have a central venous catheter placed where the patient’s CVP is being monitored. The CVP value represents what?
You are 1 minute out from arrival to the trauma centre with the unrestrained driver of a MVC who has become acutely tachycardic and hypotensive. The NIBP reads 90/78 mmHg with a pulse of 124/min, and you note the presence of electrical alternans. He is restless and visibly agitated. You look inside of the cervical collar and note that the neck veins have become markedly more distended than on your initial assessment, and you fear that he may be developing a cardiac tamponade. The most appropriate action to take in this circumstance for the patient is?
You are caring for a patient that has received a bilateral lung transplant. As you prepare to move them to your cot for transitioning out to the mobile intensive care unit, you note that the pulmonary artery catheter pressure reads 60/40. Which other hemodynamic value would help confirm this elevated PA pressure is accurate?
You have a patient with an altered mental status. When looking over their electrolyte panel as obtained by the I-STAT machine, which electrolyte disturbance may cause this alteration in mental status?
Optimizing bag valve mask ventilations is critical to assuring oxygenation in the periintubation period by the flight crew. Which of the following techniques is least helpful in achieving this goal?
You are transporting an MI patient that displays ST elevation across the precordial leads. The catheter that was performed prior to transport showed 95% occlusion in his left main coronary artery. Given this presentation, what is the likely intervention he will receive at the destination facility?
Other than transporting known diabetic patients, which of the following conditions also predisposes the patient to episodes of hypoglycaemia?
You are transporting a burn patient who is experiencing severe pain. According to your critical care medical directives, the patient meets the criteria for pain management. Which of the below agents would most likely be used for this purpose?
Which of the following blood vessels is not part of the Circle of Willis?
You are managing a patient with the following findings: tachycardia, tachypnea, hypertension, hyperthermia, and seizures. The toxic drug ingestion to most likely cause these findings is
The Swan-Ganz catheter, when properly placed, should have the tip of the device resting in what anatomical structure?
When transporting infants and children, the critical care paramedic should remember that paeds are more prone to hypoglycaemia because:
You are transporting a male to the trauma centre that was initially taken to a local ED for injuries and burns sustained in an industrial explosion. The patient currently has a heart rate of 110, blood pressure is 88/62, and respirations are 20 and unlaboured. The pulse ox reads 96%, and ETCO2 is 39 mmHg. Two IV’s of normal saline are running at a KVO rate, and the patient’s long bone fractures and burns have been initially managed by the ED. During transport, what should be the focus of treatment?
The most important component in the management of a toxic ingestion by the critical care ground medic is:
The most common aetiology of trauma related deaths in children from 1 to 4 years of age is:
When using fentanyl as a pre-intubation medication during an RSI process – what drug effect is desired?
Infusing packed red blood cells in the absence of a blood warmer will cause what type of change to the oxyhaemoglobin dissociation curve?
The patient you are transporting is a 25 year old male with ARF secondary to drug abuse. The patient has been intubated in the ED with the use of succinylcholine and is now on a propofol drip with marginal success in keeping the patient compliant on the ventilator. Prior to transport, what may the critical care provider consider using instead of propofol for ongoing sedation and paralysis?
When considering the negative feedback mechanisms in a paediatric patient, in situations of hypovolemic shock, why does the paediatric rely more on changes in heart rate than stroke volume?
Your patient is a 85kg male who sustained 40% third degree burns approximately 60 minutes prior to your interfacility critical care transport. Utilizing the Parkland burn formula how much fluid should he receive over the first 8 hours?
The purpose of achieving an O2 saturation of 99% prior to initiating the intubation attempt during an RSI procedure is directed at?
During the ongoing sedation of a patient with musculoskeletal pain, the critical care paramedic accidently administered too much fentanyl. What should be administered to correct the problem created?
Your crew is completing a 2 hour transfer of a patient who is sedated, intubated, and on a ventilator. Currently the Vt is set at 550 ml, the rate is 12/min, FiO2 is .80, PEEP is set at 5 cmH20, SpO2 is 97%, ETCO2 is 56 mmHg, and the vitals are WNL. The peak airway pressure is 21 cmH20. What change, in any, for the vent is warranted?
Regarding the review of diagnostic tests when preparing to transport a patient with an altered mental status, which of the following intracranial haemorrhages can present with xanthochromia on lumbar puncture analysis?
You are transporting a patient to a trauma centre from an outlying sister hospital. The transport time is about 60 minutes. The patient has sustained multisystem trauma, and is very unstable. About 10 minutes after departing the hospital, the patient deteriorates into cardiac arrest. What should the critical care paramedic decide regarding ongoing transport?
A patient you are transporting has a history of a drug overdose. When you review the blood gases, you find the pH to be 7.33, PaCO2 is 56 mmHg, bicarb is 24 mEq/L, and the PaO2 is 92%. What is the underlying problem with the blood gases?
While transporting an unstable patient via ground critical care, the ambulance experiences a crash and flips on its side. You are in the back of the ambulance. Once you get your bearings, you see your partner who looks unresponsive, lying prone. The patient also appears unresponsive. As smoke starts to fill the patient compartment, you detect a strong odour of fuel. You should:
When transporting a patient with syndrome of inappropriate antidiuretic hormone (SIADH) the critical care paramedic should recall that the patient may subsequently suffer from:
What abnormal result would the critical care paramedic expect to be present in the patient subjected to an electrical shock?
While transporting a patient with a known toxic exposure for haemodialysis, the critical care paramedic reads in the transfer notes that patient has had repeated exposures in the past due to dependency. This type of drug reliance is known as?
You are transporting a 36 year old male from a community hospital to a regional neurological centre for an intracranial haemorrhage. The patient is receiving a nicardipine infusion for blood pressure control. During this time, the critical care paramedic understands that the cerebral perfusion pressure (CPP) should be maintained between what two values?
What is the significance of the dicrotic notch as it pertains to the IABP?
Which of the following arterial blood gas values would you suspect to see in a patient that is diagnosed with DKA?
The oxygen dissociation curve identifies that patient’s with a SpO2 of 90% likely have a resultant PaO2 of what value?
You are summoned to transport a pediatric patient from one facility to another secondary to renal failure. Enroute to the referral facility, you are considering the most common causes of renal failure. Which one is it?
You are transporting a patient who has overdosed on Acetaminophen. You should anticipate the medical control physician to request the administration of what medication as an antidote?
You are transporting a burn injury patient 2 days post-burn. When looking at the iSTAT results, what lab value is most likely to become deranged in this patient with a severe burn injury?
When treating pediatric asthma, increased mucous cell production in the airways can result in what type of pulmonary problem?
While reviewing the new medications being placed on the critical care ground unit, the paramedic notices that a tocolytic has been added. This medication should be in which protocol?
You are summoned to transport a young adult patient with recurrent SVT from a small outlying hospital to its larger sister hospital. The patient is currently hemodynamically stable after pharmacological and electrical interventions. The ED physician mentions to NOT to give a calcium channel blocker if the SVT returns. Given this, what underlying cardiac pathophysiology do they likely have?
The intra-aortic balloon pump (IABP) is indicated in all of the following patients except?
Which form of brain herniation refers to downward displacement of the cerebellum through the foramen magnum?
While transporting a patient with a suspected intracranial lesion, which of the following patterns of clinical findings is most suggestive of Cushing’s response?
Based on the patient displaying an “apneustic” breathing pattern, where must the apneustic centre be located in the brain stem?
When calculating a fentanyl dose for pain management after a partial thickness burn to the lower extremities and abdomen in an adult, which of the below could be an appropriate initial dose?
While transporting a patient with an ICP monitor placed, the numeric value displayed on the monitor is 9 mmHg with a wave form that looks like a set of three stair steps going down (with each palpable pulse). Vitals are: B/P 168/80, HR is 84, and the patient is on a ventilator. What does this information tell you about the patient’s ICP status?
You are going to administer succinylcholine to your patient during an RSI procedure. The patient weighs 210 pounds and the dose to be administered is 2mg/kg of a solution that has 200mg in 10 ml. What is the appropriate volume (ml) to administer?
You are transporting a patient who has ingested a multitude of recreational drugs. He is having difficulty swallowing, his tongue is protruding out of his mouth, his neck is stiff and his head is contorted onto his shoulder. The classification of drug most likely to have caused these effects are:
The condition of Tetralogy of Fallot involves what pathophysiological changes in the neonate?
When managing a patient with an ectopic pregnancy, what may the critical care paramedic administer that the traditional prehospital medic may not administer?
Infants are frequently thought to be having seizures, when in fact the muscular motion seen is due to:
Your patient has a “splitting” of the S2 heart sound. To hear this, where should your stethoscope be placed?
When intubating a pediatric patient during an RSI procedure, the type of laryngoscope blade most often recommended to use is the:
You are transporting via ground transport, a patient with blunt abdominal trauma that is displaying periumbilical ecchymosis. You know this finding is referred to as?
If your patient has a BNP level of 550 pg/ml, which of the below would be the most likely conclusion?
A type of brain trauma which results in an acute shearing injury to the brain and may present without CT changes is called?
Which of the following burn patterns does not meet the criteria for a critical burn, and hence would probably not be transported by the critical care ground medic?
While transporting a patient with a chest tube in, the ground critical care medical team notices that an air leak has developed. Upon removing the overlying dressing, they observe that 2 of the holes of the chest tube are outside of the chest wall. The most appropriate action at this point would be to?
To avoid the detrimental effects of and G forces from flight when transporting a patient with a known ICH that has an elevated ICP reading, what position should the patient be placed in for transport, if no contraindications exist?
During the transport of a G3P2 female with eclampsia, which of the below interventions would best eliminate the conditions associated with the eclampsia?
Which of the following ischemic patterns on a 12-Lead is of greatest concern for complications when administering traditional MONA medications?
You have performed an RSI procedure on a patient with multisystem trauma. Following successful ET placement, which medication is used to provide long term paralysis?
You have been summoned to back up a prehospital BLS unit for a farming accident where the patient was trapped under a farm tractor for nearly 2 hours until extrication. The mechanism of this injury will predispose the patient to which electrolyte abnormality?
Which of the following hemodynamic parameters is most indicative of cardiogenic shock?
You are transporting a multisystem trauma patient from a small community hospital to the regional trauma center. Beyond customary bedside monitoring, the patient currently has 2 IV’s established, is being manually ventilated, and has had an NG tube placed. While packaging the patient, you review the recently obtained chest xray and review it. Which of the following chest x-ray findings would be of greatest concern?
The only depolarizing neuromuscular blocker (NMB) paralytic in use is?
Your patient experienced 2 hours of consistent chest pain prior to driving themselves to the hospital. The outlying emergent care facility has called you to transport the patient to the hospital ED. The nurse shows you a 12-Lead that has ST elevation in V1 & V2. These changes likely represent:
When reviewing the history of a patient to be transported by the ground critical care unit, which of the following conditions in the high risk OB/GYN patient is not a predisposing factor for post partum hemorrhage should delivery occur enroute to the destination facility?
You are preparing to transfer a neuro patient that has an intraventricular ICP monitor placed. As you transfer the patient to your portable equipment, what is the name of the physiologic position that the transducer for the ICP monitor be positioned?