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?

Enroute phaseScenario: The paramedic unit is dispatched to a group home for a 26-year-old male who is reportedly experiencing a psychiatric crisis. The call was received at 1012. The estimated response time is 6 minutes. The paramedic is partnered with an EMT, and a BLS fire engine crew is also responding. It is overcast and 54°F (12°C) with light traffic. According to dispatch, the patient is locked in his room, yelling that people are trying to hurt him. Staff report he has a history of schizophrenia and is off his medications.OnScene phaseScenario: The patient (approx. 70 kilograms) is pacing rapidly in a small, cluttered bedroom. He is shouting that “they’re watching through the walls” and refuses to sit or allow physical contact. He appears disheveled, sweaty, and paranoid. Staff report he has not taken his prescribed medications for three days. No weapons are visible, and the patient has not made threats of violence. He is not responding to attempts at de-escalation and continues to shout and mumble incoherently.Vital signs: BP 138/88, HR 116, RR 20, SpO₂ 98% RA, Temp 99.2°F (37.3°C). No signs of trauma are present. Postscene phaseScenario:With law enforcement assistance, the patient is safely escorted to the stretcher and secured with soft restraints. He continues to speak incoherently but does not resist transport. An IV is established for access, and cardiac monitoring is applied. The patient is drowsy during transport but occasionally becomes agitated and pulls at the restraints. He does not acknowledge EMS crew or answer questions. Vitals are stable: BP 130/84, HR 102, RR 18, SpO₂ 99% on room air, Temp 98.9°F (37.2°C).Why is transport to a psychiatric-capable facility appropriate even if the patient calms down en route?

A patient complaining of chest pain is also having difficulty breathing.  The patient states that he ate 3 hours ago, he takes aspirin and coumadin on a daily basis, and his pain started 20 minutes before 911 was called. Which of the assessment findings from the above scenario best illustrates the utilization of the OPQRST mnemonic?