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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.Which of the following should be included in the handoff report to the receiving facility?

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?

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?

You are called to the home of a six-month-old male infant with an irregular breathing pattern and poor feeding for the past couple of days.  Upon your arrival, you find the small patient in his mother’s arms.  The mother is attempting to feed the child from a bottle.  Primary (Initial) assessment reveals lethargy, hyperpnea, and pallor.  Mother reports a two-day history of poor feeding, vomiting, and diarrhea. Upon a more detailed examination of this infant, you might expect to find which of the following?

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).Which ECG finding is most commonly associated with congestive heart failure in elderly patients and requires close monitoring due to its impact on cardiac output?

You are called to the scene of a 70-year-old female patient complaining of lower leftsided colicky pain.  The patient has a low grade fever, nausea, and vomiting, and she called you because she had a bloody bowel movement.  She describes the stool as bright red.  This patient is MOST likely suffering from:

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. What is the most appropriate immediate intervention for this patient?

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?

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?

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?