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?

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?

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?

Enroute phaseScenario:The paramedic crew is dispatched to a public library for a 34-year-old male who is reported to be unconscious in the restroom. The call was received at 1217. The response time is estimated at 6 minutes. The paramedic is partnered with an EMT, and a BLS fire engine crew is also en route. The temperature is 66°F (19°C), with clear skies and light pedestrian traffic. The caller, a library staff member, reports the patient was found slumped on the floor and is “barely breathing.” No known medications or allergies have been reported. OnScene phaseScenario:The patient (approx. 80 kilograms) is found supine on the floor of a public restroom stall. He is unresponsive, pale, and breathing slowly. His airway is partially obstructed by relaxed oral tissues. A tourniquet is seen on his left arm with a syringe nearby. No signs of trauma are present. He does not respond to verbal stimuli but withdraws from pain.Initial vital signs are: blood pressure is 102/64 mmHg, pulse is 56 bpm, respirations are 6 per minute and shallow, SpO₂ is 86% on room air, temperature is 97.5°F (36.4°C). Pupils are 1 mm and minimally reactive. BVM ventilation is initiated with high-flow oxygen. PostScene phaseScenario: After naloxone is administered intranasally, the patient becomes more alert and begins breathing spontaneously. His respiratory rate increases to 14 breaths per minute, and SpO₂ rises to 96% on supplemental oxygen. He is drowsy, slightly confused, and speaks in short sentences. He denies using any drugs but agrees to transport. IV access is established, and the patient remains on continuous monitoring during transport.Updated vitals: BP 110/70, HR 72, RR 14, SpO₂ 96% on nasal cannula at 4 L/min, Temp 98.1°F (36.7°C).What complication is most likely to occur during transport following opioid reversal?

Enroute phaseScenario:The paramedic unit is dispatched to a residential care facility for an 82-year-old male who is experiencing difficulty breathing and is unable to lie flat. The call was received at 0915. Estimated response time is 6 minutes. The paramedic is partnered with an EMT, and a BLS fire engine crew is also responding. It is a cool fall morning, 48°F (9°C), with overcast skies and light traffic. According to staff on scene, the patient has a history of heart problems. They report the patient was doing well earlier in the day but became increasingly short of breath after breakfast and now appears pale and anxious.Based on the patient’s presentation and reported medical history, which medication combination most strongly supports a diagnosis of congestive heart failure?

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.OnScene phaseScenario:The patient (approx. 85 kilograms) is alert and seated outside the home. He has partial-thickness burns across the anterior chest, both forearms, and hands, with blistering and severe pain. His eyebrows and nasal hairs are singed, and he has a persistent cough. He is hoarse and has soot around the mouth and nose. No other trauma is observed. The patient reports using a fire extinguisher and then evacuating himself. He is anxious and asking for help.Initial vital signs: BP 134/88, HR 126, RR 28, SpO₂ 94% on room air, Temp 99.1°F (37.3°C), Pain 9/10. PostScene phaseScenario:The patient is transported in a position of comfort on high-flow oxygen. IV access is established, and fluid resuscitation is initiated per Parkland formula guidelines. The patient’s pain is treated with fentanyl titrated to effect. He remains alert but becomes more hoarse en route and develops increased work of breathing. Vital signs are monitored continuously. A burn center consult has been requested via online medical direction. Updated vitals: BP 128/82, HR 112, RR 32, SpO₂ 92% on oxygen, Temp 99.4°F (37.4°C), Pain 4/10 after treatment.What is the primary purpose of fluid resuscitation in the early treatment of burn patients?

Enroute phaseScenario:The paramedic unit is dispatched to a residential care facility for an 82-year-old male who is experiencing difficulty breathing and is unable to lie flat. The call was received at 0915. Estimated response time is 6 minutes. The paramedic is partnered with an EMT, and a BLS fire engine crew is also responding. It is a cool fall morning, 48°F (9°C), with overcast skies and light traffic. According to staff on scene, the patient has a history of heart problems. They report the patient was doing well earlier in the day but became increasingly short of breath after breakfast and now appears pale and anxious.OnScene phaseScenario:The patient (approx. 75 kilograms) is found sitting upright in a recliner, visibly dyspneic and anxious. He is gasping for air, speaking in one- to two-word sentences, and using accessory muscles to breathe. Lung sounds are diminished with bilateral crackles. The patient has jugular vein distension and pitting edema in both lower extremities. He is pale and diaphoretic. Staff report that the patient missed his morning doses of furosemide and metoprolol. Initial vital signs: BP 178/96, HR 118 (irregular), RR 30, SpO₂ 86% on room air, Temp 97.6°F (36.4°C).What medication would be appropriate for this patient if systolic blood pressure remains >100 mmHg and no contraindications are present?

The head of the baby has just delivered.  Which of the following should you do NEXT?

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.Which preparation step is most important for this type of call?