1. Which of the following findings during your general impression would MOST strongly indicate a patient is “sick” and requires immediate intervention?

2. A 34-year-old male is found sitting on the curb after a motor vehicle collision. He is holding his chest and says, “It hurts when I breathe.” His skin is pale and diaphoretic. Based on your general impression, what is your INITIAL determination about this patient?

3. You are assessing a 67-year-old female with sudden onset of difficulty breathing. She is sitting upright in bed, leaning forward with her hands on her knees. Her skin is cool and diaphoretic. What does this patient’s position MOST likely indicate about her respiratory status?

4. You arrive at the scene of an unconscious 45-year-old male who fell from a ladder. He is supine on the ground and not responding to verbal stimuli. You hear gurgling sounds when he breathes. What should be your FIRST action?

5. A 22-year-old female is found unconscious after a witnessed seizure. She has snoring respirations at 8 breaths per minute. Her pulse is strong and regular. What is the MOST appropriate initial airway intervention?

6. You are assessing a 58-year-old male with severe respiratory distress. He is able to speak only two to three words at a time before gasping for breath. He has audible stridor on inspiration. His oxygen saturation is 88% on room air. What condition should you suspect?

7. A 30-year-old male was involved in a motor vehicle collision. He is conscious but complaining of neck pain. His airway is patent, and he is speaking clearly. You note that he was the unrestrained driver. What is the MOST appropriate method to open his airway if it becomes compromised?

8. You respond to a 52-year-old male complaining of chest pain. Upon arrival, you find the patient sitting in a chair, appearing anxious. He tells you, “I feel like something bad is happening.” His skin is pale, cool, and diaphoretic. He speaks in full sentences. Vital signs show BP 88/60, pulse 110, respiratory rate 22. Based on your general impression and initial assessment findings, what is your PRIMARY clinical impression?

9. You are called to a residence for a 4-year-old child who is choking. Upon arrival, the mother reports the child was eating grapes when she started coughing and gagging. The child is conscious, crying, and coughing forcefully. You hear stridor-like sounds between coughs. Her color is pink. What is the MOST appropriate immediate action?

10. A 19-year-old male is found unconscious at a party. Friends report he “had a lot to drink.” The patient is unresponsive to painful stimuli, has vomit in his mouth, and is breathing at 6 breaths per minute with gurgling sounds. After you suction the airway, what finding would indicate that your airway intervention has been SUCCESSFUL?

11. When assessing a conscious patient’s mental status using the AVPU scale, what does the “P” represent?

12. Which pulse site is preferred when assessing circulation in an unresponsive infant?

13. A 34-year-old male is found sitting on a park bench. When you approach, he opens his eyes and looks at you but does not respond when you ask his name. You gently shake his shoulder and he mumbles something unintelligible. What is his AVPU score?

14. A 45-year-old female was involved in a motor vehicle collision. She is conscious and talking, but you note her radial pulse is absent. Her skin is pale and cool. What is the clinical significance of the absent radial pulse in this patient?

15. A 67-year-old female with diabetes is found confused and diaphoretic at her home. Family reports she seemed fine an hour ago. Her blood glucose is 42 mg/dL. Which clinical finding would you MOST expect during your primary assessment?

16. During a primary assessment, you palpate a weak, thready radial pulse in a 52-year-old male complaining of abdominal pain. His skin is cool, pale, and moist. His radial pulse rate is 118 beats per minute. What should you conclude about his circulatory status?

17. You are assessing a 6-month-old infant who is crying vigorously. You note her skin is pink, warm, and dry. You palpate the brachial pulse and count 140 beats per minute. The infant’s capillary refill time is less than 2 seconds. How would you interpret these findings?

18. A 22-year-old male was thrown from his motorcycle and struck his head on the pavement. Bystanders report he was unconscious for approximately 2 minutes, then “woke up” and seemed fine. When you arrive 15 minutes after the incident, he is confused, cannot tell you where he is, and does not remember the accident. He has a superficial abrasion on his forehead. His vital signs are BP 148/92, P 58, R 12. What condition should you suspect, and what is your priority intervention?

19. A 58-year-old male is found unresponsive in his kitchen. He has snoring respirations at 8 breaths per minute. His skin is flushed and cherry-red in color. You detect a strong, bounding carotid pulse but cannot palpate a radial pulse. What is your PRIMARY assessment finding, and what is the most likely cause?

20. You respond to a nursing home for a 76-year-old female with altered mental status. Staff report she was normal yesterday but today is difficult to arouse and “not making sense.” Assessment reveals a GCS of 11, blood glucose of 380 mg/dL, and deep, rapid respirations at 28 breaths per minute. Her skin is warm and dry. Which condition is most likely, and what metabolic process is occurring?

21. According to the START triage system, a patient who is not breathing after a simple airway maneuver should be tagged as which category?

22. When forming a general impression of a patient, which observation would be MOST concerning?

23. A 72-year-old female fell at home and has a hip fracture. She is alert but her blood pressure is 148/92 mmHg and heart rate is 88 bpm. Her skin is warm and dry. Why might this patient still be considered a priority despite normal vital signs?

24. You arrive at the scene of a motor vehicle collision. A 45-year-old male is sitting on the curb. As you approach, you note he is holding his chest, appears short of breath, and his lips have a bluish tint. What is your immediate priority?

25. You are triaging patients at a bus accident using the START method. A 35-year-old male is lying on the ground, not responding to your voice. He has a respiratory rate of 8 breaths/min, weak radial pulse, and opens his eyes only when you pinch his shoulder. What triage tag should be applied?

26. A 6-month-old infant is found unresponsive in his crib. The mother states he was fine when she put him down for a nap 2 hours ago. The infant is pale, limp, and does not respond to touch or voice. What should guide your general impression of this patient?

27. You are called to a restaurant where a 34-year-old pregnant woman at 32 weeks gestation suddenly collapsed. Upon arrival, she is supine on the floor, diaphoretic, with a blood pressure of 88/54 mmHg and heart rate of 110 bpm. She is confused. Which of the following BEST explains her condition and the appropriate intervention?

28. You respond to a call for a “person down” at a local park. On arrival, you find a 68-year-old male lying on a bench. He responds to verbal stimuli with incomprehensible sounds. His skin is warm, dry, and pink. His respirations are 16 breaths/min and regular. His radial pulse is present and regular at 76 bpm. Which component of your general impression would be MOST concerning and why?

29. You are triaging at the scene of a house explosion with multiple casualties. You assess four patients simultaneously. Patient A is walking around asking for help with a bleeding arm. Patient B is lying motionless, breathing rapidly at 35 breaths/min. Patient C is sitting against a wall, breathing normally, with an obvious leg deformity but following commands. Patient D is unresponsive with no breathing despite opening the airway. Which patient should be treated FIRST?

30. A 4-year-old child is brought to you by his mother after falling from a swing. The child is crying loudly, holding his left arm, and reaching for his mother. What does this general impression indicate about the child’s status?

31. Which breathing pattern is most characteristic of a patient in diabetic ketoacidosis (DKA)?

32. A patient opens his eyes only when you pinch his trapezius muscle, mutters incomprehensible sounds, and localizes to the painful stimulus. What is his Glasgow Coma Scale score?

33. You are assessing a 67-year-old male who is alert but speaking in two-word sentences due to shortness of breath. His respiratory rate is 28/min with good chest rise. What is the MOST appropriate initial airway intervention?

34. A 52-year-old woman is found unresponsive in her home. Family states she has a history of alcoholism. On assessment, she does not open her eyes to voice, but opens her eyes and withdraws from a sternal rub. She moans but does not form words. What is her AVPU level and GCS score?

35. A 34-year-old male was found unresponsive after a heroin overdose. He has a respiratory rate of 6/min with shallow chest rise. His skin is cyanotic. What is the priority intervention?

36. A 19-year-old male was struck in the head during a fight. He opens his eyes to verbal stimuli, is confused and disoriented, and has purposeful movement to command. Which statement BEST describes his condition?

37. A 72-year-old female with a history of stroke presents with gurgling respirations and is unable to swallow her secretions. She opens her eyes when you call her name but does not follow commands. What is the MOST appropriate airway management sequence?

38. You respond to a motor vehicle collision. A 45-year-old male was an unrestrained driver. He is unresponsive, with unequal pupils (left 6mm nonreactive, right 3mm reactive), decerebrate posturing to pain, and a respiratory rate of 8/min with irregular pattern. His blood pressure is 180/110 mmHg. Which physiological process is MOST likely occurring, and what is your priority intervention?

39. A 58-year-old male with suspected cardiac arrest has agonal gasps at 4/min. Your partner begins chest compressions. Another EMT attempts to insert an oropharyngeal airway, but the patient gags and retches. What is the BEST course of action?

40. A 28-year-old female is found by her roommate after an unknown length of unconsciousness following a reported heroin overdose. She responds to painful stimuli by opening her eyes and withdrawing. She makes incomprehensible sounds but no words. Her roommate gave naloxone 5 minutes ago. How would you classify her current level of consciousness, and what change would you expect if the naloxone is effective?

41. Which of the following best describes the appearance of arterial bleeding?

42. A 34-year-old male has a deep laceration to his forearm from a table saw. Bright red blood is spurting from the wound. Direct pressure has been applied for 3 minutes but bleeding continues heavily. What is your next action?

43. You respond to a motor vehicle collision. There are three patients. Patient A is walking around and complaining of neck pain. Patient B is sitting on the curb, alert, with a deformed right thigh. Patient C is unconscious, not responding to voice, and has unequal pupils. Which patient is your highest priority?

44. A 22-year-old female presents with pale, cool, diaphoretic skin after a fall. Her heart rate is 112 bpm and blood pressure is 118/76 mmHg. Her mental status is anxious but appropriate. These findings most likely indicate:

45. You are called to a residence for a 67-year-old male with chest pain. Upon arrival, you find the patient sitting in a chair, diaphoretic, clutching his chest. He states the pain started 20 minutes ago and describes it as “crushing.” His skin is pale and cool. Blood pressure is 148/94 mmHg, pulse is 98 bpm and irregular, respiratory rate is 22. He has a history of hypertension and diabetes. He is alert but appears anxious. Based on your primary assessment findings, which of the following represents the most accurate interpretation and priority status?

46. During a primary assessment, you palpate a weak, thready radial pulse in a 45-year-old trauma patient. The patient is alert but appears anxious. What does this finding indicate, and what is your immediate priority?

47. Which of the following patients should be classified as the highest transport priority during a mass casualty incident?

48. A 56-year-old male was found down in his bathroom. He is unresponsive to painful stimuli. You note his skin is cyanotic, cold, and mottled. His pulse is 40 bpm and very weak. His blood pressure is 72/48 mmHg. He has slow, agonal respirations at 6 per minute. Your partner is preparing to assist ventilations with a bag-valve mask. Based on these primary assessment findings, what is your interpretation of this patient’s condition and immediate priority?

49. You arrive on scene of an industrial accident. A worker has been impaled by a metal rod in his right upper thigh. The rod is still in place with minimal external bleeding. The patient is alert, pale, and reports pain at 8/10. His vital signs are: BP 100/68 mmHg, pulse 110 bpm, respirations 20. Which of the following correctly identifies his priority status and appropriate action?

50. A 28-year-old female was involved in a high-speed motor vehicle collision. She was an unrestrained driver. She is alert but confused. Her skin is pale, cool, and diaphoretic. Blood pressure is 94/62 mmHg, pulse is 128 bpm, respirations are 28. She reports abdominal pain and you note distension and tenderness to palpation. Capillary refill is 4 seconds. Based on these findings, what is your assessment of this patient’s condition and the primary pathophysiology?