You are treating a 76-year-old male who presents with dizziness, fatigue, and syncope. On arrival, he is conscious but confused. Vitals: HR 32, BP 78/42, RR 16, SpO2 95%. The cardiac monitor reveals a regular rhythm with a ventricular rate of 30 bpm and more P waves than QRS complexes. There is no consistent relationship between the P waves and QRS complexes. IV access is established, and oxygen is being administered. Transcutaneous pacing is available but not yet initiated. What is the most appropriate next intervention?

A 66-year-old male is found sitting on his porch complaining of palpitations and dizziness. He is diaphoretic, with a heart rate of 180 bpm and BP of 80/40. ECG reveals wide-complex tachycardia. What is the most appropriate treatment?

You are treating a 5-year-old cardiac arrest patient who weighs 40 lbs. What is the correct initial epinephrine dose?

A 10 kg child in cardiac arrest requires defibrillation. What is the correct first shock dose?

A 60-year-old male is found sitting on the couch complaining of substernal chest pain that began 20 minutes ago while walking. His vitals are stable: HR 88, BP 134/86, RR 18, SpO2 98% on room air. ECG is normal. You suspect ACS. What is the most appropriate initial intervention?

EMS responds to a 62-year-old female found pulseless and unresponsive at a restaurant. CPR is in progress, and the monitor shows ventricular fibrillation. After three defibrillation attempts, the rhythm persists. What medication should be administered next?

A 17-year-old male collapses during football practice. Bystanders begin CPR and an AED is applied, which advises a shock. What should you do next?

A 44-year-old patient achieves ROSC after two shocks and one dose of epinephrine. Vitals: SpO2 96%, BP 92/64. What is your next step in care?

Pediatric cardiac arrest is usually caused by primary cardiac arrhythmia.

A 6-year-old weighing 22 kg is in V-fib arrest. What is the correct amiodarone dose to administer?

EMS is dispatched to a seafood restaurant where a 36-year-old male is experiencing difficulty breathing, stridor, and hypotension after eating shrimp. He is alert but anxious, with flushed skin and a BP of 78/40. What is the most appropriate first-line treatment?

A BGL of 60 mg/dL in an adult with AMS warrants IV dextrose administration.

A 22-year-old patient is postictal after a witnessed tonic-clonic seizure. He is breathing adequately, GCS 10, and protecting his airway. What should you do?

You respond to a call for an altered patient. A 70-year-old diabetic is combative and diaphoretic. Blood sugar is 40 mg/dL and IV access is unsuccessful. What is your next best step?

A 4-year-old with fever and brief seizure activity is alert upon your arrival. What is the next appropriate action?

A patient reports right lower quadrant pain and vomiting. Vitals are stable. What is the most appropriate intervention?

Midazolam is appropriate for treating active seizures in the prehospital setting.

A 20 kg child is actively seizing. What is the correct IM dose of midazolam?

A 29-year-old overdose patient has HR 116, BP 142/88, RR 6, SpO2 89%. What should you do first?

Which patient most likely requires sepsis alert activation?

A 70-year-old is febrile, hypotensive, and confused. What are your priorities?

A 9-month-old is found cyanotic and unresponsive. What is your first action?

What breathing pattern is most consistent with metabolic acidosis?

A 12 kg child with hypoglycemia needs dextrose. What dose and concentration is preferred?

A patient with AMS has BGL of 22 mg/dL and is combative with no IV access. What is the next best step?

Which medication is contraindicated in TCA overdose due to proarrhythmic potential?

In a suspected sepsis case, which value indicates impaired perfusion?

Pediatric seizures lasting >5 minutes require benzodiazepines.

A 6-year-old with asthma has SpO₂ of 88% and audible wheezing. What should be administered first?

How many times may Albuterol be repeated in severe distress?

Which is an absolute contraindication to CPAP?

You arrive on scene to a 72-year-old male with a known history of congestive heart failure. He is sitting upright, gasping for air, with audible gurgling respirations. He is alert but unable to speak in full sentences. His skin is pale and diaphoretic. Vitals are: BP 186/104, HR 112, RR 36, SpO₂ 82% on room air. He is producing copious amounts of pink, frothy sputum. Lung sounds reveal diffuse crackles bilaterally. What is the most appropriate immediate treatment to stabilize this patient?

Epinephrine IM is used in status asthmaticus not responding to beta-agonists.

A COPD patient continues to wheeze after Albuterol/Ipratropium. SpO₂ is 89%. What is next?

You are treating a 19-year-old female who was found unresponsive with an empty bottle of aspirin nearby. She is breathing rapidly and deeply. Vitals: HR 118, RR 34, BP 122/78, SpO2 98% on room air. You place her on EtCO2 monitoring and find a reading of 24 mmHg. What is the most likely cause of the low EtCO2 in this patient?

A 55-year-old in status asthmaticus remains unresponsive after Albuterol. What drug should be given next?

A patient has severe bronchospasm and can’t speak full sentences. Which respiratory rate is most concerning?

What is the respiratory rate in severe distress suggesting fatigue and failure?

Pediatric respiratory failure is often preceded by prolonged respiratory distress.

A COPD patient has tremors and palpitations after treatment. What is the likely cause?

CPAP is helpful in all EXCEPT:

A 34-year-old in respiratory distress becomes bradycardic and cyanotic. What does this indicate?

A 12 kg infant is in respiratory failure. What BVM rate should be used?

What EtCO₂ reading indicates hypoventilation?

You arrive at the scene of a high-speed MVC involving a 25-year-old male who was the unrestrained driver. He is found semi-conscious with labored breathing. Upon assessment, you note diminished breath sounds on the left side, distended neck veins, and poor chest rise with ventilation. His blood pressure is 84/50, heart rate is 132, and SpO2 is 86% despite high-flow oxygen.

Which of the following indicates impending respiratory failure?

A 22-year-old male is bleeding profusely from the thigh. A tourniquet has been applied but bleeding continues. What should you do next?

A 30-year-old female has blunt chest trauma, JVD, hypotension, and muffled heart tones. What is the most likely diagnosis?

A patient opens eyes to pain, makes incomprehensible sounds, and withdraws to pain. What is the GCS?

A 2-year-old has partial-thickness burns on the entire left arm and anterior torso. What is the estimated TBSA?

A 25-year-old male has blunt abdominal trauma, hypotension, and no external bleeding. What should you suspect?

A 60-year-old hit by a car is unconscious with snoring respirations. What airway maneuver is best?

A woman is actively delivering and shoulder dystocia is encountered. What should you do first?

You are called to a residence for a 32-year-old female who is 36 weeks pregnant. Her husband states she had a seizure lasting about one minute prior to your arrival. On assessment, she is postictal, has significant facial edema, and complains of a headache and visual disturbances. Vitals: BP 186/112, HR 98, RR 20, SpO2 99%. Based on the presentation, what condition should you suspect, and what is the most appropriate initial treatment?

A pregnant woman in her third trimester is hypotensive after trauma. She is supine on the stretcher. What should you do?

A newborn is apneic but has a heart rate over 100 bpm. What is the next best action?

You are dispatched to a home birth in progress. Upon arrival, you find a 29-year-old female who delivered a baby approximately 12 minutes ago. The newborn is breathing spontaneously but appears slightly cyanotic and limp. The mother is alert but pale, anxious, and soaked in blood-soaked linens. You palpate a boggy uterus, and heavy vaginal bleeding continues. Her vitals are: BP 92/60, HR 134, RR 26, SpO2 97%. Your partner begins neonatal care. As the lead provider, what is your first priority in managing the mother?

A 24-year-old with bradycardia and BP 70/40 requires atropine. What is the correct initial adult dose?

You arrive on scene to a 45-year-old male actively seizing. What is your initial midazolam dose?

You are dispatched to a 4-year-old child with a fever and brief seizure activity. On arrival, the child is alert and responsive. What is the next best action?

A 29-year-old male is found unconscious in his bathroom with an empty bottle of pain medication nearby. HR 116, BP 142/88, RR 6, SpO₂ 89%. What is your first intervention?

You respond to a residence for an elderly patient with altered mental status. The family reports she has had a fever for two days. Vitals: BP 84/54, HR 102, RR 22, T 101.8°F. What should you do first? 

You arrive to find a 6-year-old wheezing with audible breath sounds and SpO₂ of 88%. What is the most appropriate first treatment? 

A 70-year-old male complains of sharp chest pain and difficulty breathing after a long flight. HR 114, SpO₂ 91%, lungs are clear bilaterally. What is your most appropriate intervention? 

During a multi-patient MCI, you have one dose of TXA left. Which patient is the best candidate? 

You are called to a rural home for a 70-year-old male with altered mental status. He is found lying on the floor, incontinent, GCS 9, febrile at 103.1°F, and hypotensive. Family reports recent UTI. What is your next best action? 

A 24-year-old female complains of sudden shortness of breath after stepping off a flight. She is tachycardic, mildly hypoxic, and complains of pleuritic chest pain. What is your most appropriate prehospital treatment? 

A 6-year-old child has progressive respiratory distress. They are sitting upright, drooling, and unable to speak. What is your next best action? 

You are dispatched for a 70-year-old male experiencing acute neurologic deficits. Upon arrival, the patient presents with right-sided facial droop, slurred speech, and complete left-sided weakness. His wife reports the symptoms began approximately 6 hours ago. His RACE score is calculated to be 9. Blood glucose is 94 mg/dL, and vitals are stable. You are equidistant (18 minutes) from both a primary stroke center and a comprehensive stroke center with thrombectomy capabilities. 

According to best practice and DCEMS protocol, where should this patient be transported?