Life Link III: New Hire Exam

A patient has just been intubated for respiratory distress after blunt trauma related to an ATV vs tree collision. His EtCO₂ is 38 mmHg and oxygen saturations 94% on 100% FiO₂. The breath sounds are diminished on the left with positive gastric sounds in the left chest. The next priority is to:

The most reliable objective method for verification of placement of a tracheal tube during transport is:

Immediately after intubation of a hemodynamically unstable patient the EtCO2 reading is 2 mmHg. The clinician recognizes the best explanation of this is that:

An elderly female trips and falls from a standing position to concrete. She has a GCS 13, moves all extremities with a C- collar in place. Vital signs are a blood pressure of 130/80, heart rate of 60, and respiratory rate of 10. During your assessment she becomes apneic. The next most appropriate step is to:

A construction worker has a diagnosed C4 injury in the ED. During your assessment, you note his GCS is 14 with no movement of extremities and no feeling below the nipple line. His blood pressure is 93/60, HR 80, respiratory rate 28, oxygen saturation 100% on 2 liters by nasal cannula, and EtCO2 70 mmHg. The clinician recognizes the next MOST appropriate action is to:

A 28-week gestation female complains of severe headache and blurred vision. The patient’s vital signs are BP 160/110, HR 76, and RR 20. During your assessment, the patient develops a generalized seizure. Which medication is indicated first in this situation?

An adult female patient who was involved in an MVC is in an emergency department. The patient is supine on a long backboard with a cervical collar in place. Her current vital signs are BP 78/42, HR 128, and RR 24. The patient responds to loud verbal stimuli and is confused. Your physical exam reveals no external hemorrhage or major injuries. The patient has a visibly gravid abdomen. Your first intervention is to:

The normal pH range for arterial blood is?

An adult male patient presents to a hospital with anxiety, confusion, diaphoresis, nausea and vomiting, diarrhea, and hypersalivation. He developed these symptoms while working in an orchard. His vital signs are BP 140/90, HR 58, and RR 20. Which of these medications would you administer first?

An adult patient who was diagnosed with DKA is being transferred to higher level of care. The patient is intubated and mechanically ventilated at 12 breaths per minute with 400 mL of tidal volume. The most recent arterial blood gas results are pH 7.0, PaCO₂ 36, PaO₂ 72, and HCO₃ 10. The most appropriate next intervention is to:

The management of a patient experiencing an acute hemorrhagic stroke includes which of the following?

The two main physiologic changes that cause shock in the septic patient are

Upon arrival at a remote hospital, you are presented with a patient who suffered facial burns 26 hours previously. He is experiencing respiratory distress and you are requested to intubate the patient prior to transport. Which of the following medications used for rapid sequence induction should be avoided on this patient?

Which of the following would be appropriate personal protective equipment for providers during transport of a patient with high fever, respiratory distress, hypoxia, and frequent cough?

A 56-year-old male patient complains of substernal chest pain. The 12-lead ECG was diagnostic for an anterior STEMI. The patient’s vital signs are BP 138/86, HR 68, RR 14, and he currently rates his pain at 8/10. The patient was placed on oxygen and received Aspirin and SL Nitroglycerin. Which of these medications would be contraindicated in this situation?

A 58-year-old patient presents with weakness, respiratory failure, decreased level of consciousness, hypotension, and wide complex bradycardia. The patient has a history of end-stage chronic renal failure. Based on this information you know that the patient may require the administration of:

A patient is receiving antibiotics. They develop a rash on their trunk and develop inspiratory and expiratory wheezing. The next most appropriate action is to:

An adult trauma victim is being transported from a local hospital to a Level I trauma center. The patient is receiving the second unit of 0 negative packed red blood cells. During the transport, the patient begins experiencing itching, hives, and chills. The NEXT step is to:

Management of a patient with a descending aortic dissection that has not ruptured would most likely include which of the following drug therapies?

The best measure of adequate fluid resuscitation in a 2-year-old would be:

You administer sublingual nitroglycerin to a patient for chest pain. What would indicate the need for further intervention during transport?

You are about to administer hypertonic saline to a pediatric patient who weighs 30 kg. The order states to administer 5 ml/kg over 15 minutes. You program the infusion pump to deliver:

During the assessment of your patient, they develop the following rhythm. Interpret this rhythm strip.

A young female is diagnosed with a massive pulmonary embolism. Physical assessment reveals pale, cool, diaphoretic extremities, and chest pain on inspiration. Vital signs blood pressure 70/30, heart rate 128, respiratory rate 36. The next MOST appropriate action is to?

An adult patient arrives in the ED with a confirmed acute inferior wall MI. The vital signs include blood pressure is 82/50, heart rate 110, and respiratory rate 24 with oxygen saturations of 98%. The clinician anticipates the next most appropriate actions is to:

A recently intubated adult, head injury patient is in the ED awaiting transfer. The patient was sedated and paralyzed 30 minutes ago with midazolam (Versed), and rocuronium (Zemuron). During your care the patient’s blood pressure changes from 130/70 to 170/100 and heart rate from 75 to 110. What is the MOST appropriate next intervention?

During the pre-hospital phase of a traumatic brain injury (TBI), which two conditions reduce survival of this patient population?

A pregnant patient (34 weeks gestation) is complaining of severe abdominal pain and loss of fetal movement. She describes the pain as sudden and severe in her abdomen. Assessment reveals that the patient is alert, anxious, with a pulse rate of 120, a blood pressure of 124/98, and cool and clammy skin. The patient has heavy, dark vaginal bleeding. The MOST likely diagnosis is:

A 2-year-old child has been diagnosed with decompensated hypovolemic. Which of the following solutions and volumes would you choose to administer initially?

A two-year-old child is brought into the emergency department by his parents. They report that the child is not breathing normally. A quick assessment reveals an unresponsive child with agonal breathing, cyanosis, and weak, slow central pulses. Heart rate is 45. Your initial action should be:

An initial assessment of a newborn infant following warming, drying, and stimulation, reveals peripheral cyanosis, a pulse of 80 bpm, flexed arms and legs with minimal response to stimulation, and no cry. The most appropriate next intervention is to:

Which of these drugs is known primarily to lower afterload or systemic vascular resistance?

Which of these drugs’ primary action is to improve cardiac contractility?

A late sign of increased intracranial pressure (ICP) involves which changes?

A motorcyclist hits a cow at a high rate of speed on a country road. The patient is unresponsive and intubated upon your arrival at the scene. His breath sounds are clear bilaterally with no JVD. After two liters of isotonic fluid for a blood pressure of 80/50, the current vital signs are BP 84/58, HR 128, oxygen saturations 96%, EtCO₂ 32 mmHg, RR 16 assisted by BVM. The next most appropriate action is to:

A patient with a femur fracture and possible pelvic fracture is being prepared by you and your partner for transport. The patient has received 3 L of crystalloid solution, 1 unit of packed red blood cells, and 1 unit of FFP. The clinicians should focus their initial efforts on:

On the scene is a patient with a stab wound to the right upper quadrant of the abdomen. The blood pressure is 88/50, HR 104, RR 22 with oxygen saturations of 94% on high flow supplemental oxygen. The next most appropriate action is to:

A protester is hit with a can of soup in the left temporal area. The patient was initially found unresponsive and is now alert and oriented, complaining of a headache. During transport, the patient’s level of consciousness begins to deteriorate. The clinician expects the patient to have which type of condition?

An adult victim was extricated from a burning building. The patient sustained a flash burn to the upper chest and face in a dryer explosion. The most concerning assessment findings in this patient would be:

Assessment of a patient with a blunt injury to the right chest reveals hypoxia, jugular vein distention, subcutaneous emphysema, and a decrease in blood pressure. The most appropriate action is to:

During the transport of a patient suffering from compartment syndrome in a lower extremity following isolated trauma, you note a complete absence of distal circulation in the extremity. You consult a physician’s medical direction who states the patient needs an emergency fasciotomy. You have received no training on this procedure. The most appropriate action is to:

A 17-year-old was struck by a baseball in the left temporal area. He sustained a depressed skull fracture and developed a left fixed gaze with a fixed and dilated pupil on the left, and a 3mm reactive to the light pupil on the right. Vital signs are a blood pressure 190/110, heart rate 52, respiratory rate irregular pattern with the rate of 24 per minute. The patient is unconscious. The clinician recognizes this is consistent with:

A young male has a penetrating wound in the right upper chest near the armpit. His vital signs are blood pressure 80/50, heart rate 104, respiratory rate 36, and oxygen saturation of 80%. The patient is restless with distended neck veins on physical exam. The clinician recognizes the patient MOST likely has a

An anxious adult patient arrives in the ED with vital signs of a blood pressure 64/48, pulse 130, respirations 28, temperature 97.1° F, and pulse oximetry of 94%. Physical exam revealed muffled heart sounds and the presence of jugular venous distension (JVD). The patient is one week post coronary bypass graph (CABG) x 5. The clinician recognizes the patient MOST likely has a:

An intubated and mechanically ventilated trauma patient is being flown by your team from a small community hospital to a large tertiary center. Several minutes into the flight you note that the patient’s pulse oximetry decreased suddenly, a high-pressure alarm appeared on the ventilator, and the left side of the patient’s chest is not moving with each breath. Your immediate action is to:

The oxygen saturation reading on an intubated, mechanically ventilated patient is 88%. To improve the oxygenation in this patient, the next step would be to:

When ventilating a pediatric patient in respiratory failure due to asthma exacerbation, the ventilation strategy should include which of the following?

Which of the following statements regarding positive end-expiratory pressure (PEEP) is true?

A patient is being mechanically ventilated. The MD states that he would like to improve ventilation. The clinician expects to adjust which values?