NREMT EMT - Emergency Medical Technicians Exam

Comprehensive and Detailed Explanation From Exact Extract:

Laundry detergent ingestion — especially in the case of liquid detergent pods — is associated with caustic airway and gastrointestinal injuries. The presence of crackles and drowsiness are signs of aspiration and possible respiratory failure. Vomiting increases the risk of aspiration pneumonitis, and esophageal perforation is a life-threatening complication from corrosive ingestion.

While seizure and hypoglycemia are possible complications of toxic ingestion, they are not as immediately linked to the detergent profile as airway injury and aspiration risk.

Comprehensive and Detailed Explanation From Exact Extract:

The patient is in hypoperfusion (shock) from blood loss. In shock states, tissues are deprived of oxygen, leading to anaerobic metabolism, which produces lactic acid as a byproduct. This causes metabolic acidosis, which is a critical sign of systemic oxygen debt.

Carbon dioxide rises with respiratory failure, but lactic acid is a more specific indicator of cellular hypoxia.

Using the START triage system, patients are categorized based on Respirations, Perfusion, and Mental Status (RPM).

A respiratory rate greater than 30 breaths per minute immediately qualifies the patient as RED (Immediate). Additionally, delayed capillary refill (>2 seconds) further supports this classification.

Option A is correct.

Option B applies to stable patients who can wait.

Option C is for deceased or nonsalvageable patients.

Option D is for minor injuries.

NREMT teaches that patients with compromised airway or perfusion are the highest priority.

Comprehensive and Detailed Explanation From Exact Extract:

In cases of sexual assault, preserving evidence integrity is critical. Clothing or other forensic evidence must be placed in paper bags. Plastic or non-breathable materials can trap moisture, promoting mold or degradation of evidence like DNA or bodily fluids.

This approach follows chain-of-custody protocols used by law enforcement and medical facilities for handling forensic material.

Comprehensive and Detailed Explanation From Exact Extract:

The position of the patient’s head within the aircraft affects access to airway management and crew maneuverability. If the head is oriented away from providers or toward a non-accessible bulkhead, this can delay critical interventions (airway suctioning, ventilations).

Use of air splints, maintaining oxygen saturation, or environmental humidity are not major complications relative to physical positioning and in-cabin access limitations.

According to NREMT guidelines and standard EMS ethics, a competent adult patient has the legal right to refuse any portion of medical care, including spinal immobilization, as long as they demonstrate decision-making capacity. In this scenario, the patient is refusing one specific intervention (the cervical collar), not transportation or overall care. Therefore, EMS providers must respect the patient’s autonomy while continuing to act in the patient’s best interest.

Option A is correct because the appropriate action is to clearly document the patient’s informed refusal of the cervical collar and continue transport. Documentation should include the patient’s mental status, orientation, explanation of risks provided, the patient’s understanding of those risks, and the patient’s explicit refusal. This protects both the patient and the EMS provider legally and ethically.

Option B is incorrect because restraining a patient to force treatment constitutes assault and battery unless the patient lacks decision-making capacity or poses an immediate danger to themselves or others. There is no indication in the question that the patient is incompetent or combative.

Option C is incorrect because the patient has not refused all care—only spinal immobilization. Abandoning care by leaving the scene would violate EMS duty to act once patient contact has been established.

Option D is incorrect because withholding transport unless the patient complies is coercive and unethical. EMS providers must not threaten or pressure patients into accepting treatment.

In summary, NREMT emphasizes patient rights, informed consent, and thorough documentation. Transporting the patient while documenting refusal of immobilization is the safest, most professional, and legally sound course of action.

Comprehensive and Detailed Explanation From Exact Extract:

This is a classic presentation of hypovolemic shock due to traumatic blood loss (open femur fracture, pelvic instability). Indicators include:

Low BP (86/42) = hypotension

High pulse (P 136) = compensation

Mental status decline (responsive only to voice) = indicates decompensated shock

Obstructive and distributive shock are not applicable. Compensated shock would show normal BP and alert mental status.

In an unresponsive diabetic patient, EMTs must rapidly determine whether the cause is hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose) because immediate management priorities differ. According to NREMT education, skin signs are the most reliable and quickly observable indicator when a blood glucose reading is not immediately available.

Hypoglycemia typically presents with cool, pale, and diaphoretic skin due to a sympathetic nervous system response. In contrast, hyperglycemia often presents with warm, dry skin, reflecting dehydration and lack of insulin-mediated glucose uptake.

Option D is correct because skin color and condition provide the most useful differentiation in the field.

Option A may help identify diabetic ketoacidosis (Kussmaul respirations) but is not the most consistent finding.

Option B is unreliable and nonspecific.

Option C may vary but does not clearly distinguish between the two conditions.

NREMT emphasizes treating unresponsive diabetics as hypoglycemic until proven otherwise, while using skin findings to guide clinical suspicion.

Comprehensive and Detailed Explanation From Exact Extract:

Contraindications to CPAP (Continuous Positive Airway Pressure) include:

Hypotension: CPAP can reduce preload and worsen shock (BP < 90 systolic is a contraindication)

Respiratory rate too low: A rate of 10 is at the low threshold; CPAP requires spontaneous adequate effort

Active vomiting or nausea: CPAP increases aspiration risk

Crackles and hypoxia are indications, not contraindications, for CPAP. Pulse rate does not influence CPAP use directly.