Enroute phaseScenario:The paramedic crew is dispatched to a private residence for a 21-year-old female who was found unresponsive in her bedroom by her roommate. The call was received at 1535. The response time is estimated at 7 minutes. The paramedic is partnered with an EMT, and an ALS supervisor is en route. It is a mild spring afternoon, 64°F (18°C), and traffic is light. The roommate reports by phone that the patient has a history of depression and may have ingested “a bunch of pills.” The patient takes amitriptyline and alprazolam, according to the caller. Law enforcement is not yet on scene.What is the primary concern about airway management in suspected overdose?

Enroute phaseScenario: The paramedic unit is dispatched to an elementary school nurse’s office for a 7-year-old female who developed difficulty breathing and a rash shortly after eating lunch. The call was received at 1147. Estimated response time is 6 minutes. The paramedic is partnered with an EMT, and a BLS engine crew is also en route. The temperature is 72°F (22°C) and skies are clear. According to the school nurse, the child has a known peanut allergy and her symptoms started within minutes of exposure. The school has an EpiPen available and is awaiting EMS arrival.On scene phaseScenario:The patient (25 kg) is found sitting upright in the school nurse’s office, visibly distressed. She is scratching at her neck and chest, which are covered in raised, red hives. Her lips are swollen, and she is audibly wheezing. The child is anxious and only able to speak in two- to three-word phrases. The nurse confirms that she did not yet administer the EpiPen but did place the child on oxygen via non-rebreather mask. The child’s caregiver has been contacted and is en route to the school.Vital signs: BP 88/52, HR 144, RR 30, SpO₂ 91% on oxygen, Temp 98.4°F (36.9°C).Post scene phaseScenario:The child’s breathing improves within minutes of receiving epinephrine. She is now able to speak in full sentences and is less anxious. Oxygen saturation has increased, and the hives are beginning to fade. IV access is established, and the child remains on 4 L/min oxygen via nasal cannula. The caregiver meets the crew during transport and rides in the front seat of the ambulance. The child remains stable and alert but still complains of a “tight throat.” En route, you prepare for possible recurrence of symptoms. Updated vitals: BP 94/60, HR 126, RR 20, SpO₂ 97%, Temp 98.4°F (36.9°C). What is the most important reassessment finding during transport?

Enroute phaseScenario:The paramedic crew is dispatched to a private residence for a 21-year-old female who was found unresponsive in her bedroom by her roommate. The call was received at 1535. The response time is estimated at 7 minutes. The paramedic is partnered with an EMT, and an ALS supervisor is en route. It is a mild spring afternoon, 64°F (18°C), and traffic is light. The roommate reports by phone that the patient has a history of depression and may have ingested “a bunch of pills.” The patient takes amitriptyline and alprazolam, according to the caller. Law enforcement is not yet on scene.OnScene phaseScenario: The patient (approximately 60 kilograms) is found supine on her bedroom floor. She is unresponsive to verbal stimuli but withdraws from painful stimuli. There are several empty medication bottles nearby labeled amitriptyline 50 mg and alprazolam 1 mg. Pupils are dilated and sluggishly reactive. The patient’s skin is warm and dry. No signs of trauma are noted. Vital signs are: BP 88/50, HR 132, RR 8, SpO₂ 91% on room air, Temp 97.8°F (36.5°C). ECG shows sinus tachycardia with a wide QRS complex.PostScene phaseScenario: The patient is ventilated with a BVM and oxygen. A large-bore IV is established, and sodium bicarbonate 1 mEq/kg IV is administered. ECG shows slight QRS narrowing post-treatment. The patient remains unconscious but has a palpable radial pulse. En route to the ED, she begins posturing with one arm flexed and jaw clenching. Updated vitals: BP 92/56, HR 122, RR assisted at 12, SpO₂ 98%, ECG QRS 110 ms.What is the primary goal of sodium bicarbonate administration in this scenario?

Enroute phaseScenario:The paramedic unit is dispatched to a residential structure fire for a 42-year-old male reportedly burned while attempting to extinguish flames in his kitchen. The call was received at 0758. Estimated response time is 7 minutes. The paramedic is partnered with an EMT, and a BLS engine company is also responding. The outside temperature is 62°F (17°C) on a clear spring morning. According to fire personnel on scene, the patient has burns to the chest and arms and was exposed to smoke for several minutes before exiting. He is reported to be conscious but in significant pain.Based on the nature of the incident, what complication should the paramedic anticipate beyond thermal injury?

You are called to a private home to care for a 16-year-old-female who was found passed out on the bathroom floor but now has regained consciousness.  She is cool and pale, with sweaty skin.  Her pulse is 128, BP is 86/44, and respirations are 22 and shallow. She will not answer questions with her mother in attendance.  After getting the mother out of the area, the patient states she has had heavy vaginal bleeding while on the toilet. This started just today.  The condition that needs the most urgent treatment with this patient is:

You are called to treat a patient with a history of a brain tumor who has a blood pressure of 200/100, respirations of 4, pulse of 40, and temperature of 102 degrees Fahrenheit. Which of the following is your MOST appropriate initial intervention?

A three-year-old child was found wandering in a neighborhood park.  You are called to evaluate and most likely, transport the child to the hospital.  You see that the child has old bruises in multiple areas of his body along with burn scars.  These are present on all limbs, the back and abdomen.  You suggest to the police that the best explanation for these injuries is:

Enroute phaseScenario:The paramedic unit is dispatched to a residential structure fire for a 42-year-old male reportedly burned while attempting to extinguish flames in his kitchen. The call was received at 0758. Estimated response time is 7 minutes. The paramedic is partnered with an EMT, and a BLS engine company is also responding. The outside temperature is 62°F (17°C) on a clear spring morning. According to fire personnel on scene, the patient has burns to the chest and arms and was exposed to smoke for several minutes before exiting. He is reported to be conscious but in significant pain.What pre-arrival preparation is most appropriate for this patient’s presentation?

Enroute phaseScenario: The paramedic unit is dispatched to an elementary school nurse’s office for a 7-year-old female who developed difficulty breathing and a rash shortly after eating lunch. The call was received at 1147. Estimated response time is 6 minutes. The paramedic is partnered with an EMT, and a BLS engine crew is also en route. The temperature is 72°F (22°C) and skies are clear. According to the school nurse, the child has a known peanut allergy and her symptoms started within minutes of exposure. The school has an EpiPen available and is awaiting EMS arrival. Based on dispatch information, which symptom most strongly suggests the child is experiencing anaphylaxis?

You are assessing a patient with a fracture involving the maxilla, nasal bones and crossing the orbital rim who was initially rendered unconscious, regained consciousness, and is now unconscious again.  Which of the following is MOST likely occurring?